Midarm circumference is measured by a flexible tape at a point midway between the tip of the acromion process
of the scapula and the olecranon process of the ulna with the flexion at the elbow joint.
The morphometry of the acromion process
is important as it is related to pectoral girdle pathologies (Saha & Vasudeva, 2017).
The markers were secured with medical double-sided adhesive tape on: (a) the lateral wrist epicondyle (average point between the ulnar and the radial styloid process); (b) the elbow (lateral epicondyle of the humerus); and (c) the shoulder (clavicular acromion process
The acromion process
projects forward at right angle as a flattened plate from the lateral end of the spine of the scapula.
Taping of the middle part of deltoid muscle begun by attaching the first 4 cm of the strip over the acromion process
with no stretch.
Carpenter, "Fractures of the acromion process
: a proposed classification system," Journal of Orthopaedic Trauma, vol.
At the region just lateral to the surface projection overlying the acromion process
of the scapula, skin tissue that was taken along the circumferential line of joint was considered as "horizontal," while that perpendicular to it was considered as "vertical."
For the A-GT distance measurements, the lateral edge of the acromion process
and the nearest margin of the superior part of the greater tuberosity of the humerus were identified on USG imaging, and the distance was measured between these two bony landmarks (Figure 1).
Manual palpation revealed extreme laxity along with complete separation of the distal clavicle from the acromion process
. Upper limb neurological and vascular examination was normal.
Shoulder angles (ShoFlex, ShoAbd) were calculated as the angle between the vector joining the ipsilateral acromion to the lateral epicondyle and the vector from the acromion process
towards the hip in the sagittal plane.
Mechanical pain sensitivity was measured using a digital pressure algometer (Wagner Instruments, Greenwich, CT) with a 1 cm diameter rubber tip manually applied at a rate of 1kgF/s over the dominant upper trapezius muscle belly and 2 cm lateral to the midpoint between the seventh cervical vertebrae and the acromion process
. Pressure pain threshold (PPT) was defined as the lowest pressure at which the subject verbally indicated that the sensation of pressure was first perceived as slightly painful.
The axis of rotation was aligned as the line from the olecranon process through the humerus to the acromion process
, ensuring that the subject had full, safe range of motion.