15th November 2018
The Kinetic Medial Rotation Test (KMRT) has been part of the Kinetic Control test battery since our first course in 1995. This cognitive movement control test is designed to identify uncontrolled movement (UCM) at both the scapula and gleno-humeral joint (GHJ) (Comerford & Mottram, 2012). It is a popular test with clinicians as it signposts the presence of UCM at the scapular and/or GHJ and therefore directs targeted interventions.
Lost choices in movement: compromised Movement Health:
Cognitive movement control assessments evaluate an individual's ability to cognitively coordinate movement at a specific joint or region (site) in a particular plane of movement (direction). In this test we are exploring the ability to control anterior translation of the humeral head, anterior tilt, downward rotation and elevation of the scapula during 60° of medial rotation (with the humerus in the plane of the scapular and at 90° abduction (see figure below). Whilst it is rare for movement to be either eliminated at one joint system while moving at another, or to move in one plane only, the ability to consciously coordinate the body's degrees of freedom in this manner can be used as test of movement control (Dingenen 2018). This test can identify the presence of uncontrolled movement, defined as “an inability to cognitively control movement at a specific site and direction while moving elsewhere to benchmark standards” and can be representative of a loss of choice in coordinative strategies (Comerford & Mottram, 2012).
This test helps identify lost choices in patterns of co-ordination
Test procedure:
Start position:
Start supine / humerus in 90° abduction (hand to the ceiling) / humerus supported in the plane of the scapula. The therapist palpates the coracoid and humeral head.
Test movement:
Person moves the arm, into medial rotation to a benchmark range of 60°, and limits the presence of any observable UCM. The therapist palpates and observes for uncontrolled movements at the scapula and/or at the GHJ
Description of ideal pattern:
While supine or standing, with the shoulder in 90° of abduction (scapular plane), there is 60° of medial rotation of the humerus without significant scapula-thoracic movement (anterior tilt, downward rotation, elevation; or gleno-humeral anterior translation).
Patterns of risk associated with the Kinetic Medial Rotation Test:
Scapular uncontrolled movement (traditionally called impingement patterns): Scapular forward tilt, downward rotation or elevation occurs before 60° GHJ medial rotation is achieved. Confirm the impingement risk with orthopaedic tests and palpation
Uncontrolled glenohumeral anterior translation occurs before 60° GHJ medial rotation is achieved. Note anterior displacement of humeral head with coracoid maintaining stable position. Confirm with GH instability tests
The accuracy of this palpation has been measured (Morrissey et. al. 2008).
Reliability: the need for skilled testers:
Research exploring the reliability of the test has highlighted the need for accuracy with respect the therapist’s skills of observation and palpation (Lluch et al., 2014; Rajasekar et al., 2017). In 2014 Lluch and colleagues reported the reliability of the test was acceptable when performed by experts but poor for the novice. More recently, Rajasekar et al. (2017) identified substantial agreement interrater reliability. Therefore, practice of the skill of observation, palpation and cueing during is key to ensure the test’s results can best assist subsequent clinical decision making.
Click here to view a practical video.
References:
· Comerford, M., & Mottram, S. (2012). Kinetic Control-e-book: The Management of Uncontrolled Movement. Elsevier Health Sciences.
· Dingenen, B., Blandford, L., Comerford, M., Staes, F., & Mottram, S. (2018). The assessment of movement health in clinical practice: A multidimensional perspective. Physical Therapy in Sport.
· Lluch, E., Benítez, J., Dueñas, L., Casaña, J., Alakhdar, Y., Nijs, J., & Struyf, F. (2014). The shoulder medial rotation test: an intertester and intratester reliability study in overhead athletes with chronic shoulder pain. Journal of Manipulative and Physiological Therapeutics, 37(3), 198-205.
· Morrissey, D., Morrissey, M.C, Driver, W., King, J.B., Woledge, R.C. (2008) Manual landmark identification and tracking during the medial rotation test of the shoulder: An accuracy study using three-dimensional ultrasound and motion analysis measures. Manual Therapy 13( 6) 529-535
· Rajasekar, S., Bangera, R. K., & Sekaran, P. (2017). Inter-rater and intra-rater reliability of a movement control test in shoulder. Journal of Bodywork and Movement Therapies, 21(3), 739-742.
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