Scapulohumeral reflex of Shimizu

Shimizu T, Shimada H, Shirakura K, Scapulohumeral reflex ( Shimizu ): its clinical significance and testing maneuver. Spine. 1993; 18:2182-90

Reflex Description
Description of a case series to substantiate the use of the scapulohumeral reflex (Shimizu variant technique) to detect cervical myelopathy above the C3 vertebral body level. The reflex is of value only when hyperactive and bilateral. It consists of elevation of the scapula or humerus or both upon tapping the tip of the scapula or the acromion. One can become familiar with the abnormal response by eliciting it unilaterally in stroke patients.

Searching or a muscle stretch reflex that is innervated by the high cervical cord, the authors discovered the scapulohumeral reflex (Shimizu)-SHR (Shimizu). The testing maneuver, localization of the reflex center, its clinical significance, and the designation of the SHR (Shimizu) are dealt with in this report.

The SHR is elicited by tapping the tip of the spine of the scapula and acromion in a caudal direction. The SHR is classified as hyperactive only when an elevation of the scapula or an abduction of the humerus have been clearly defined after tapping at these points.

Application to Chiropractic

The SHR (Shimizu) is a muscle stretch reflex (MSR) discovered in 1993 while researching MSR’s innervated by the higher cervical cord. It was known prior to this research that precise information regarding C0-C4 spinal cord segments represented a blind spot in exam procedures.

While the jaw reflex (brain stem) and biceps reflex (C5,C6) yielded objective evidence of function at those levels, there was no objective method to determine cervical myelopathy from C0-C4. Since alterations in intensity and character of the MSR may be among the earliest and most delicate indications of disturbance of neural function, it is a highly objective procedure, unlike some other methods.

 

Links to other sites referencing this reflex are found below:

American College of Physicians

The Aging Spine

The Heads Up on Cervical Myelopathy: A Cautionary Tale

Abstract of Article
Searching for a muscle stretch reflex that is innervated by the high cervical cord, the authors discovered the scapulohumeral reflex (Shimizu)--SHR (Shimizu). The testing maneuver, localization of the reflex center, its clinical significance, and the designation of the SHR (Shimizu) are dealt with in this report. The SHR is elicited by tapping the tip of the spine of the scapula and acromion in a caudal direction.

The SHR is classified as hyperactive only when an elevation of the scapula or an abduction of the humerus have been clearly defined after tapping at these points. Two hundred twenty-five patients with cervical spine disorders, 90 normal individuals, and 17 patients with cerebrovascular strokes were examined. The incidence of hyperactive SHR was highest among several neurologic abnormalities in spastic cases with craniovertebral or high cervical lesions, and all cases with hyperactive SHR in the cervical spine disorder group exhibited neural compressive factors at the high cervical region.

The major muscles participating in the SHR are considered to be the upper portion of the trapezius, the levator scapulae, and the deltoid. According to the anatomic level of compressive factors and the postoperative course of the activity in hyperactive SHR cases, the reflex center of the SHR is clinically presumed to be located between the posterior arch of C1 and the caudal edge of the C3 body. Hyperactive SHR provides useful information about dysfunctions of the upper motor neurons cranial to the C3 vertebral body level. 03622436Spine. 1993 Nov ;18 (15):2182-90