4-Type Classification by Kibler

Execution:

  1. The patient performs 3 repetitions of bilateral shoulder elevations in the scapular plane at a speed of 45°/s
  2. Afterwards, the patient performs 3 repetitions of bilateral shoulder abduction at a speed of 45°/s
  3. The examiner observes for winging and/or dysrhythmia

 

Outcomes:

  1. Type I: Inferior angle prominent
  • At rest: Inferior medial border prominent dorsally
  • During arm motion: Inferior angle tilts dorsally + acromion tilts ventrally over the top of the thorax
  2. Type II: Medial border prominent
  • At rest: Entire medial border prominent dorsally
  • During arm motion: Medial border tilts dorsally off the thorax
  2. Type III: Superior border prominent
  • At rest: Superior border elevated + scapula anteriorly displaced
  • During arm motion: Shoulder shrug initiates movement without winging of the scapula
  2. Type IV: Symmetric scapulohumeral
  • At rest: Both scapulae symmetrical (dominant arm might be slightly lower)
  • During arm motion: Symmetrical upward rotation without winging or tipping

 

Study Reliability Sn Sp LR+ LR-
Kibler et al. (2002)

Intra к = 0.5

Inter к= 0.4

 NA NA NA NA
Comment: Uhl et al. (2009) evaluated the validity of the 4-type classification against 3D kinematic assessment and found a low accuracy between 54% and 65%.