Pearl M L, Jackins S, Lippitt S B, Sidles J A, Matsen F A
From the University of Washington, Department of Orthopaedics, Seattle, Wash.
J Shoulder Elbow Surg. 1992 Nov;1(6):296-305. doi: 10.1016/S1058-2746(09)80056-6. Epub 2009 Feb 19.
Positions of the arm are traditionally described in relation to the thorax. Yet shoulder pathology most often lies in and about the glenohumeral joint, which then becomes the focus of treatment. Little is known about the relative motion between the humerus and the scapula primarily because there is no clinically accepted method for assessing and describing these positions. This paper proposes a clinical method for describing and measuring humeroscapular positions based on an anatomic definition of the plane of the scapula. Humeroscapular positions achieved by 75 normal subiects during a conventional (humerothoracic) shoulder range-of-motion examination are presented. Identification of the plane of the scapula is based on four palpable anatomic landmarks: (7) the inferior pole of the scapula, (2) the medial border of the scapula at the level of the scapular spine, (3) the posterolateral corner of the acromion, and (4) the tip of the coracoid. The plane of the scapula is defined by the line connecting the first two of these points and a point midway between the last two. Humeroscapular positions are specified by the plane of elevation and the angle of elevation in relation to this mobile scapular plane. Measurement of these positions was done with a goniometer facilitated by a "scapula-locating device" designed for this study. Maximal humerothoracic elevation of the arm was achieved with the humerus lust behind the scapular plane at 90° of humeroscapular elevation. Cross-body adduction positioned the humerus in a plane 51° anterior to the plane of the scapula, with most of the cross-body motion occurring between the scapula and thorax. External rotation at 90° of elevation in the coronal plane of the body (the apprehension position) positioned the humerus in a plane 17° posterior to the scapular plane. Humerothoracic extension and reaching up the back took place at very low angles of humeroscapular elevation.
传统上，手臂的位置是相对于胸部来描述的。然而，肩部病变大多位于盂肱关节及其周围，因此该关节成为治疗的重点。人们对肱骨和肩胛骨之间的相对运动知之甚少，主要是因为目前尚无临床上可接受的评估和描述这些位置的方法。本文基于肩胛骨平面的解剖学定义，提出了一种描述和测量肩肱位置的临床方法。文中呈现了75名正常受试者在常规（肱骨胸廓）肩部活动度检查过程中所达到的肩肱位置。肩胛骨平面的确定基于四个可触及的解剖标志：（1）肩胛骨的下极；（2）肩胛冈水平处的肩胛骨内侧缘；（3）肩峰的后外侧角；（4）喙突尖。肩胛骨平面由连接前两个点的直线以及后两个点之间中点的连线所确定。肩肱位置由相对于这个可移动肩胛骨平面的抬高平面和抬高角度来指定。这些位置的测量使用了角度计，并借助为此研究设计的“肩胛骨定位装置”来进行。当肱骨位于肩胛骨平面后方，肩肱抬高90°时，手臂实现最大肱骨胸廓抬高。体侧内收使肱骨位于肩胛骨平面前方51°的平面内，大部分体侧运动发生在肩胛骨和胸廓之间。在身体冠状面抬高90°（恐惧位）时进行外旋运动，使肱骨位于肩胛骨平面后方17°的平面内。肱骨胸廓伸展和向上够背部时，肩肱抬高角度非常小。
