Apley Scratch Test: Other Names, Purpose, and Interpretation

What is the other name for apley scratch test?

The Apley Scratch Test is also commonly referred to as the Apley Shoulder Test or, more descriptively, a Functional Shoulder Mobility Assessment. It is a widely used clinical and fitness assessment tool designed to evaluate the range of motion of the shoulder joint complex.

Introduction to the Apley Scratch Test

The Apley Scratch Test is a simple yet effective physical examination maneuver used to quickly assess the overall mobility and functional range of motion of the shoulder joint, specifically focusing on internal and external rotation, adduction, and abduction. Developed by orthopedic surgeon William Apley, it provides a rapid screen for shoulder dysfunction, often indicating potential issues with the rotator cuff, joint capsule, or surrounding musculature.

The "Other Name": Functional Shoulder Mobility Assessment

While "Apley Shoulder Test" is a direct alternative name, the term "Functional Shoulder Mobility Assessment" perhaps best captures the essence of what the Apley Scratch Test aims to achieve. This descriptive name highlights that the test evaluates the shoulder's ability to perform movements essential for daily activities and athletic endeavors, rather than isolating specific anatomical structures. It assesses the combined range of motion across multiple planes, reflecting the complex, multi-axial nature of the glenohumeral joint and scapulothoracic articulation.

Anatomy and Biomechanics Behind the Test

Understanding the biomechanics of the shoulder is crucial for interpreting the Apley Scratch Test. The shoulder is a highly mobile complex comprising several joints, primarily the glenohumeral joint (ball and socket), and the scapulothoracic articulation (movement of the shoulder blade on the rib cage).

• Glenohumeral Joint: The primary joint involved, allowing extensive range of motion.
• Scapulothoracic Articulation: The movement of the scapula is vital for full shoulder elevation and rotation.
• Key Movements Assessed:
  • Internal Rotation: The ability to rotate the arm inward, bringing the thumb towards the body.
  • External Rotation: The ability to rotate the arm outward, bringing the thumb away from the body.
  • Abduction: Movement of the arm away from the midline of the body.
  • Adduction: Movement of the arm towards the midline of the body.

The test requires coordinated movement of the humerus, scapula, and clavicle, engaging muscles such as the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis), deltoids, and scapular stabilizers (e.g., serratus anterior, rhomboids, trapezius).

How the Apley Scratch Test is Performed

The test involves two distinct movements, each assessing different aspects of shoulder mobility:

• Upper Reach (Superior Reach):
  • The individual attempts to reach behind their head and touch the superior medial angle of the opposite scapula (or as high as possible on the upper back) with the fingertips of one hand.
  • This movement primarily assesses external rotation and abduction of the shoulder.
• Lower Reach (Inferior Reach):
  • The individual attempts to reach behind their back and touch the inferior angle of the opposite scapula (or as high as possible on the lower back) with the fingertips of the other hand.
  • This movement primarily assesses internal rotation and adduction of the shoulder.

Both sides are tested and compared. The distance between the fingertips of the reaching hand and the opposite scapula (or a fixed anatomical landmark like the C7 vertebra or T12 vertebra) is noted.

Interpretation of Results

The results of the Apley Scratch Test are typically qualitative, focusing on symmetry and the ability to perform the movements without pain or significant restriction.

• Normal Mobility: The individual can touch the opposite scapula (or reach a comparable level) on both sides without pain or significant difficulty.
• Restricted Mobility: Inability to reach the opposite scapula, significant asymmetry between sides, or reproduction of pain during the movement.
• Potential Underlying Issues Indicated by Restriction:
  • Rotator Cuff Pathology: Tendinopathy, tears, or impingement, particularly affecting external rotators (superior reach) or internal rotators (inferior reach).
  • Adhesive Capsulitis (Frozen Shoulder): Generalized stiffness and loss of range of motion in all directions.
  • Acromioclavicular (AC) Joint Dysfunction: Pain at the top of the shoulder.
  • Scapular Dyskinesis: Impaired movement of the shoulder blade, affecting overall shoulder mechanics.
  • Postural Imbalances: Such as rounded shoulders or thoracic kyphosis, which can limit shoulder mobility.

Clinical Relevance and Applications

The Apley Scratch Test is a valuable tool for a variety of professionals:

• Screening Tool: It serves as an excellent initial screen for shoulder pathology in general physical examinations, sports pre-participation screenings, or fitness assessments.
• Baseline Assessment and Progress Tracking: For individuals undergoing rehabilitation for a shoulder injury, the test can establish a baseline range of motion and track improvements over time. In fitness, it can monitor the effectiveness of mobility drills.
• Identifying Asymmetries: It quickly highlights significant differences in mobility between the dominant and non-dominant shoulders, which can be a precursor to injury or a sign of compensatory movement patterns.
• Guiding Further Assessment: A positive (restricted or painful) Apley Scratch Test often prompts a more detailed orthopedic examination, including specific special tests and potentially imaging studies.

Limitations and Considerations

While useful, it's important to acknowledge the limitations of the Apley Scratch Test:

• Non-Diagnostic: It is a screening tool, not a definitive diagnostic test. It can indicate a problem exists, but not precisely what the problem is. Further evaluation is always required for diagnosis.
• Influence of Other Factors: Thoracic spine mobility, posture, body composition (e.g., large musculature or adipose tissue), and pain tolerance can influence the test's outcome, potentially leading to false positives or negatives.
• Qualitative Nature: The assessment is largely subjective and depends on the examiner's observation and the individual's effort. Quantifying the "scratch" distance can add objectivity but still relies on consistent landmarking.
• Lack of Specificity: It doesn't isolate specific muscles or structures; rather, it assesses global shoulder function.

Conclusion

The Apley Scratch Test, or Functional Shoulder Mobility Assessment, remains a cornerstone of basic shoulder evaluation due to its simplicity and effectiveness. By quickly assessing the combined movements of internal and external rotation, abduction, and adduction, it provides valuable insights into an individual's shoulder health and functional capacity. While not a standalone diagnostic tool, its utility in screening for potential issues, tracking progress, and guiding further, more specific assessments makes it an indispensable component of any comprehensive fitness or clinical evaluation.