Standing, sitting, or lying prone
For women, a gown over the non-examined side with the examined area exposed or a halter top is recommended.
For men, removal of the shirt is requested.
Posterior to the patient.
May I place my fingers next to your shoulder blade? (or point to the demonstrated area).
(If female and wearing a halter top, you may need to ask if you can place your fingers under
the halter top and next to the shoulder blade). I am going to move your arm. Please hold this
position and do not let me move you.
Position the shoulder in horizontal adduction to move the scapula and lateral rhomboid major laterally, so they are not covered by the lower trapezius. The patientÃs upper limb is supported with the examinerÃs positioning hand. With the patient relaxed, place your fingers just medial to the vertebral border of the scapula at the attachment of the rhomboid major. Ask the patient to maintain that position while you resist horizontal abduction isometrically. Gradually increase resistance and gradually release resistance. (Glenohumeral horizontal abduction effort activates both the glenohumeral horizontal abductors and the scapular retractors, one of which is the rhomboid major).
VH - close up of the posterior scapula with skin and trapezius removed.