Scapular Assistance Test

Original Editor - Lilian Ashraf
Top Contributors - Lilian Ashraf

Introduction

Coordinated movement of the scapula is needed for normal function of the shoulder joint. During humerus elevation the scapula moves into upwards rotation, external rotation and posterior tilt.[1] 

Scapula dyskinesis or abnormal scapular movement has been associated with many shoulder pathologies.[2]

Purpose

Scapular assistance test is used to assess scapular motion which may be linked to shoulder pain.[3]

It is a symptom alteration test in which the examiner assists the scapula into upwards rotation and posterior tilt as the patient elevates the arm, simulating the force couple of serratus anterior and lower trapezius muscles[3]

The scapula upward rotation and posterior tilt performed influence the subacromial space, relieving the pressure on the tendon and bursa of subacromial space, thus helping in identifying patients whose pain is related to subacromial impingement.[1]

Technique

The test was first described by Kibler to involve scapula upward rotation only, then it was modified to include posterior tipping of the scapula, as posterior tipping movement is also lacking is in individuals with subacromial impingement.

The examiner stands behind the patient, one hand on the superior boarder of the scapula of the involved shoulder with the fingers over the clavicle, and the other hand on the inferior angle of the scapula with the fingers wrapped laterally around the thorax.

The examiner assists the scapula upwards rotation by pushing the inferior angle of the scapula upwards and laterally, and assists posterior tipping of the scapula by pulling the superior angle of the scapula posteriorly, while the patient actively elevates the arm. 

The test is positive if the symptoms of impingement decrease or abolish.[2]

Evidence

Alon Rabin et al found that when the modified scapula assistance test was perfoermed in scapular plane kappa coefficient and percent agreement were 0.53 and 77%, respectively, and when the test was performed in the sagittal plane it was 0.62 and 91%, respectively. Concluding that the modified scapula assistance test has moderate interrater reliability, making it acceptable for clinical use.[2]

References

  1. 1.0 1.1 Seitz AL, McClure PW, Lynch SS, Ketchum JM, Michener LA. Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation. Journal of Shoulder and Elbow Surgery. 2012 May 1;21(5):631-40.
  2. 2.0 2.1 2.2 Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. Journal of Orthopaedic & Sports Physical Therapy. 2006 Sep;36(9):653-60.
  3. 3.0 3.1 Ribeiro LP, Barreto RP, Pereira ND, Camargo PR. Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test. Clinical Biomechanics. 2020 Mar 1;73:166-71.