Scapulohumeral Rhythm
Normal abduction = 180°. Approx. 120° glenohumeral + 60° scapulothoracic. Ratio ≈ 2:1.
🧭 Compass Test — OSTEOPATHY Framework
- Push toward feet: anterior humeral head / glenohumeral joint
- Push toward head: AC joint
- Push across body: sternoclavicular joint
- Palm away, push away: first rib / thoracic outlet
Shoulder Tests
| Test | Assesses | Position | Positive Finding | Modification |
|---|---|---|---|---|
| Compass | GH, AC, SC, 1st rib | Supine/seated | Weakness/pain direction-specific | Use seated if pregnant. |
| Empty Can | Supraspinatus | Seated/standing | Pain/weakness | Geriatric: gentle resistance. |
| Drop Arm | Rotator cuff tear | Standing/seated | Arm drops | Support arm in frail patients. |
| Yergason's | Biceps tendon stability | Seated | Pain/pop in groove | No major modification. |
| Speed's | Biceps / SLAP | Standing/seated | Anterior shoulder pain | Reduce force in elderly. |
| Hawkins-Kennedy | Subacromial impingement | Seated | Pain | Very gentle if OA/frozen shoulder. |
| Neer's | Impingement | Standing/seated | Pain at end range | Avoid forced elevation in elderly. |
| Apprehension | Anterior instability | Supine/seated | Apprehension | Pregnant: seated. |
| Relocation | Confirms instability | Supine/seated | Relief of apprehension | Pregnant: seated. |
| Anterior/Posterior Drawer | GH laxity | Supine/seated | Excessive translation | Gentle in paeds/hypermobile. |
| AC Compression/Distraction | AC joint | Seated | AC pain | No major modification. |
| SC Stress | SC joint | Seated/supine | SC pain | Pregnant: seated. |
| Adson's | TOS | Seated | Pulse diminishes | Monitor carefully in pregnancy. |
Painful Arc Syndrome — Differentials
- Supraspinatus tendinopathy
- Subacromial bursitis
- Partial rotator cuff tear
- Calcific tendinitis
- AC joint pathology (often pain near end range)
References: OSTEOPATHY Year 2 Orthopaedic Sports Therapy Book; OSTEOPATHY Cervical & Thoracic Spine Assessment.