The inferior angle shoulder be level with T7. Use both hands to measure the position of four landmarks: To assess the resting position of the scapula I recommend 4-point palpation, which has been validated in previous studies (Lewis et al, 2002). Step 1: Assessment of Scapula positioningÄetermine the resting position of the scapula on the symptomatic side as this will guide further movement and muscle assessment. downward rotation, upward rotation, retraction, protraction, posterior tilt, anterior tilt, depression, or elevation. After noting scapular dyskinesis is present the next step is to determine what altered movement pattern is being observed e.g. "The term scapular dyskinesis, though indicating that an alteration exists, is a qualitative collective term that does not differentiate between types of scapular positions or motions" (Kibler, et al., 2002, p. The premise of scapular retraining is that upward rotation will raise the clavicle, decompressing the neural structures within the thoracic outlet and reducing tension/compression of neurovascular structures and muscles originating from the cervical spine (Watson, et al., 2010). Most commonly the scapula is drooped (depressed, downwardly rotated and at times anteriorly tilted). Many patients with TOS will present with altered positioning of their scapula. It was the best source of clinical information I read on this topic. The second masterclass explores the treatment strategies to manage scapular dyskinesia, muscular imbalances and improving container dysfunction (Watson, Pizzari & Balster, 2010). The first provides a comprehensive outline of the musculoskeletal examination and differential diagnosis of TOS (Watson, Pizzari & Balster, 2009). Watson and colleagues provide a two-part masterclass for Thoracic Outlet Syndrome.
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