The Tyler Test…Ya Heard?

Anytime orthopedists and physical therapists get on the topic of shoulder dysfunction, posterior capsular tightness is inevitably mentioned. A tight posterior capsule causes antero-superior migration of the humeral head relative to a a shoulder with normal capsular relationships. In the context of more extensive amounts of posterior capsular tightness, a postero-superior shift of the humeral head occurs. An association between posterior capsule tightness and loss of internal rotation range of motion (@ 90 degrees of abduction) has also been documented and has been noted to affect the dominant arm to a greater extent than the nondominant arm. Clinically, posterior capsule tightness can be qualitatively assessed by performing a posterior glide of the glenohumeral joint at 0, 45, and 90 degrees of abduction. On the other hand, internal rotation ROM is measured with the patient supine and the shoulder abducted 90 degrees with the scapula stabilized. In addition to these assessment techniqes, clinicians should also be aware of the Tyler test developed by Tim Tyler from the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT). This test assesses the limitation in cross-arm adduction and is thought to measure tightness in the posterior shoulder elements to include the posterior capsule and the musculotendious units of the posterior shoulder musculature. To perform this test, follow the steps outlined below:

1. Position the patient in sidelying with the nontested extremity under the patient’s head

2. Have the patient flex their hips and knees to 45 and 90 degrees, respectively to stabilized the body

3. Align the acromion of the tested extremity perpendicular to the plinth

4. The examiner shoulder face the patient and grasp their elbow at the epicondyles or their forearm

5. Passively abduct the shoulder to 90 degrees while maintaining neutral rotation

6. Stabilize the scapula into a position of retraction with the free hand

7. While maintaining the scapula, lower the shoulder into horizontal adduction maintaining neutral rotation

8. Lower the humerus until motion ceases or rotation of the humerus occurs

9. Record the distance from the top of the plinth to the medial epicondyle

It should also be mentioned that there is high intratester reliability (0.92-0.95) and intertester reliability (0.80) for this assessment technique.

I encourage clinicians to become aquainted with this test as it yields meaningful information that will help to guide one’s treatment plan when working with patients presenting with shoulder dysfunction.

References:

1. Clinical Examination of the Shoulder by Todd Ellenbecker 2004 Elsevier Saunders

2. Tyler et al. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement AJSM 2000

3. Tyler et al. Reliability and validity of a new method of measuring posterior shoulder tightness JOSPT 1999.