Shoulder Assessment

Stenvers Test Battery | AC, SC, Glenohumer & Scapulothoracic Joints

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Shoulder passive range of motion

Stenvers Test Battery I to V

Movement in the shoulder requires coordinated movement of several joints, namely the Sternoclavicular joint, the acromioclavicular joint, the glenohumeral joint, the scapulothoracic joint, as well as, the cervicothoracic junction.

Stenvers presented a series of tests to assess the shoulder girdle in 1977 and Baertschi et al. (2013) evaluated the tests on their inter-rater reliability and found kappa values of 0.63-0.84 though their clinical value remains questionable.

Stenvers 1: Backward Tiltiing of the scapula

Stenvers test 1 assesses backward tilting of the scapula. In order to conduct the test, the patient is in an upright sitting position and you are going to stand at the arm to be examined. Then bring the patient’s arm into maximal flexion and assess whether or not the axillar hairline is in line with the inferior angle of the scapula. 

In a positive test, posterior tilting of the scapula is limited if the inferior angle stays behind the axillar hairline.

 

Stenvers 2: Clavicular Rotation

Stenvers Test 2 assesses clavicular rotation. The patient is going to be in an upright sitting position and you’re standing posterolaterally at the side to be examined.
Place your middle or index finger on top and behind the clavicle shaft. Then the patient’s shoulder is brought into full flexion while you palpate the movement of the clavicle.

In a positive outcome, the clavicle deviates from the normal movement during flexion, which is elevation and forward rotation until at about 45° of flexion and moves downwards and makes a posterior rotation from 45° on.

 

Stenvers 3: Scapular Depression

Stenvers Test 3 assesses Scapular Depression. To conduct the test the patient is in an upright standing or sitting position. Then you are going to palpate for the inferior angle of the scapula. The patient proceeds to maximally flex the shoulder. What you are assessing is whether the inferior angle drops down 1-2 centimeters at around 170° of shoulder flexion.

 

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Stenvers Test 4: Thoracic Mobility (C7-T4)

Stenvers Test 4 assesses the cervicothoracic junction. The patient is in an upright sitting position and you’re standing posterolaterally at the side to be examined. Then palpate for the spinous process of C7 and place the thumb contralateral to the tested shoulder against the spinous process.
The patient then actively flexes the shoulder maximally.

What you are assessing is whether shoulder flexion is coupled with contralateral rotation of the vertebrae in the cervicothoracic junction. 

 

Stenvers Test 5: posterior capsule of the glenohumeral joint, the AC and SC joint 

Stenvers test 5 assesses the posterior capsule of the glenohumeral joint, the AC joint, and the SC joint. The patient is in an upright sitting position and you are standing behind them. The patient then abducts the shoulder to 90 degrees and flexes the below to 90 degrees as well. While you support the patient’s elbow with one hand, use the other hand to fixate the patient’s scapula by gripping onto the lateral border of the scapula. The patient can place their other hand in a fist on their sternum.

Then move the patient’s arm into maximal horizontal adduction while you keep the scapula fixated. This should be around 100°.

Once you reach maximal horizontal adduction, let go of the fixation and here you’d expect to be able to move another 20° into horizontal adduction.

 

References

Baertschi, E., Swanenburg, J., Brunner, F., & Kool, J. (2013). Interrater reliability of clinical tests to evaluate scapulothoracic motion. BMC musculoskeletal disorders14(1), 1-8.

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