Scapular Assistance Test Intra-rater reliability .76 - scapular elev .84 – flexion Limitation – Non-specific w/ dx./shoulder pathology

EXTERNAL ROTATION PUSH TECHNIQUE PULL TECHNIQUE  POSITION - SIDE - Scapula retracted  HAND POSITION- R PALM ON CORACOID/ (L) PALM ON MEDIAL SCAPULAR BORDER  FORCE - ( R ) HAND APPLIES POSTERO-MEDIAL FORCE ALTERNATE : ( R ) HAND ON AXILLARY BORDER PULL TECHNIQUE  POSITION - SIDE/ PRONE Scapula retracted  HAND POSITION- (R ) fingers ON CORACOID/ (L) PALM ON MEDIAL SCAPULAR BORDER  FORCE - ( R ) HAND APPLIES POSTERO-MEDIAL FORCE ALTERNATE : ( R ) HAND ON AXILLARY BORDER

POSTERIOR TILT PUSH TECHNIQUE PULL TECHNIQUE  POSITION - SIDE OR UPRIGHT - Scapula retracted  HAND POSITION- ®PALM ON CORACOID/ (L) PALM ON INFERIOR ½ OF SCAPULA  FORCE - ( R ) HAND APPLIES SUPERO-POSTERIOR FORCE Stand @ head of patient PULL TECHNIQUE  POSITION - SIDE/ PRONE/UPRIGHT -Scapula retracted HAND POSITION- ®HAND GRIPS SUPERIOR BORDER /(L) PALM ON INFERIOR ½ OF SCAPULA FORCE - ( R ) HAND PULLS INTO POSTERO-INFERIOR DIRECTION

UPWARD ROTATION FORCE - COUNTEROTATION  TECHNIQUE  POSITION - SIDE OR PRONE - Scapula retracted HAND POSITION- ( L ) WEB SPACE CUPS SUPERIOR ANGLE/ (R) WEB SPACE CUPPING INFERIOR ANGLE FORCE - COUNTEROTATION

COMBINED- UR/ POST TILT SCAPULAR ASSISTANCE TEST HAND POSITION- (L) HAND GRIPS SUPERIOR BORDER / R WEB SPACE CUPS INFERIOR ANGLE FORCE - ( L ) HAND PULLS INTO POSTERO-INFERIOR DIRECTION ( R ) HAND - PROMOTES UPWARD ROTATION

G-H MOBILIZATIONS POSTERIOR Scapular Plane Horizontal Adduction INFERIOR  Scaption (90-120˚)

G-H MOBILIZATIONS ANTERIOR  Extension  Horizontal Abduction LATERAL  “Fulcrum” Technique

MANUAL TECHNIQUES FOR THE HYPOMOBILE SHOULDER INCORPORATION OF :  SOFT TISSUE RELEASE (MUSCLE-CAPSULE) VIA CONTRACTION OF ANTAGONIST AGONIST  ACTIVE MOVEMENT  STRETCH

PRINCIPLES OF RX  APPLY MANUAL PRESSURE  MAINTAIN PRESSURE - ADD  IDENTIFY RESTRICTED TISSUE  APPLY MANUAL PRESSURE  MAINTAIN PRESSURE - ADD REPEATED CONTRACTIONS  STRETCH INTO RESTRICTED RANGE

ANTERIOR-SUPERIOR CAPSULE  MOTION AFFECTED  ER ( IN 0-45˚ OF ABD)  MANUAL PRESSURE TO:  SUPRASPINATUS TECHNIQUE  SUPINE  RESISTED ER/IR

ANTERIOR CAPSULE  MOTION AFFECTED  ER ( IN 45˚-90˚ OF ABD)  MANUAL PRESSURE:  SUBSCAPULARIS TECHNIQUE  SUPINE  RESISTED ER/IR

POSTERIOR CAPSULE  MOTION AFFECTED  IR ( IN 90˚ OF ABD)  MANUAL PRESSURE:  TERES MINOR  INFRASPINATUS TECHNIQUE  SEATED /SUPINE  RESISTED ER/IR

POSTERIOR-INFERIOR CAPSULE  MOTION AFFECTED  Horizontal Abduction  MUSCLES AFFECTED  TERES MINOR  INFRASPINATUS TECHNIQUE  Sidelying RESISTED HORIZ. ADD (ROWING MOTION)

POSTERIOR-INFERIOR CAPSULE  MOTION AFFECTED  ELEVATION (FLEX)  Horiz add.  MANUAL PRESSURE:  TERES MAJOR  LATISSIMUS DORSI TECHNIQUE  SUPINE  RESISTED FLEX/EXT