ing (7) will often demonstrate significant translation on isometric cuff testing in the direction of instability due to the inability of the rotator cuff to centralise the humeral head in the glenoid against the pull of the patterning muscle.
Assistance tests The scapula assistance test described by Kibler (21) is described as a tool to assess the effect of passively facilitating optimal scapula mechanics during elevation. The therapist facilitates posterior tilt and upward rotation/protraction of the scapu- la through elevation and assesses the effect of correction on the patient’s symp- toms (Fig.10). In patients with a pattern- ing component the therapist will often feel the patient fix against them as they attempt to move the scapula.
Balance and proprioception Quick screening tests of balance control and integration of the kinetic chain are useful tools. The Kibler 1-leg stand looks at the patient’s ability to balance on one leg. These patients often compensate
using their visual input for decreased pro- prioceptive acuity and the Kibler 1-leg stand can be repeated with eyes shut. There is often excessive use of righting reactions in these patients and significant loss of balance with eyes shut. A positive Trendelenberg or significant pelvic tilt also gives us some useful information about gluteal function. Patients with latissimus dorsi dominance will often fix with latis- simus and demonstrate a significant pelvic lateral tilt. These patients often compen- sate using their visual input for decreased proprioceptive acuity. The one-leg squat gives information about rotational control in the lower limb, the ability to maintain segmental alignment in the trunk and the tendency to fix the problem shoulder with the problem muscle. Again there is often excessive use of righting reactions. The MCTSIB can also be utilised in the clinical setting-the patient is asked to maintain each of the test positions for up to 30 sec- onds. Poor balance, poor core stability and reduced proprioceptive acuity will con- tribute to a situation where some compen- satory strategy is needed to hold every-
thing together! Assessment of propriocep- tion is also very useful, however there are obviously different aspects of this that we need to consider; joint position sense, abil- ity to match positions and accuracy of fol- lowing a target being just three. Laxity must also be considered in the subgroups - we know that patients with capsular laxity demonstrate decreased proprioception (22). The sulcus test can be used to assess cap- sular laxity in sitting or standing. The ante- rior and posterior drawer tests will also give useful information about capsular laxity or insufficiency in the patterning subgroups.
Motor control assessment Specific assessment of local and global stability of the glenohumeral joint and scapula as described by Mottram (23) and Sahrmann (8) will further demonstrate the tendency to ‘fix’ with the patterning muscle and patients will be unable to dissociate rotation control or maintain joint neutral without inappropriate acti- vation of the patterning muscle.