When Convex-Concave Rule Meets Clinical Practice

Concave-Convex Image


When Convex-Concave Rule Meets Clinical Practice

 The convex-concave rule was developed by Freddie Kaltenborn.  It has been taught for decades as the way to explain the arthrokinematics of a joint.  It identifies that when the concave joint surface moves on the convex surface, rolling and gliding occur in the same direction.  Thus, if the concave joint surface rolls posterior, it will also glide posterior.  However, if the convex joint surface moves on the concave surface, rolling and gliding occur in the opposite direction, i.e. if the convex surface rolls posterior, it will glide anterior on the concave surface. Concave-Convex Image

Simple right?  Well, several researchers have questioned if the rule applies to clinical practice.  This can be challenging to assess since we are talking about millimeters of motion.  Until now….please visit https://mobil-aider.com/ to see the latest innovation to objectively assess linear translation of a joint.

Let’s look at the shoulder with respect to internal (IR) and external (ER) rotation.  Based on the convex-concave rule, ER should be accompanied by rolling posterior and gliding anterior (convex humerus on concave glenoid fossa).  However, a study by Johnson et al (2007) compared the impact of both an anterior glide and a posterior glide of the shoulder on ER range of motion (ROM).  The results demonstrated a 31 degree increase in ER ROM with a posterior glide as compared to  just 3 degrees with anterior glides.  So how does that make sense?  An anterior glide should occur with ER.

Sigel (2020) questioned  if ER arthrokinematics be a spin instead of a roll/glide.  Although capsular tightness was not assessed in the study, Neumann (2012) suggested the efficacy of the posterior glide could be related to capsular tightness. Thus, a posterior glide could centralize the humeral head in the glenoid fossa.  This centralization could unload the anterior capsule to  provide more linear translation in the anterior direction for more ER.

The take home message is the convex-concave rule is a wonderful guiding principle but the  assessment of the joint limitation is paramount.  Neumann states we “should not mobilize a pathological joint according to a rule, but treat pathological clinical findings, which are in correlation with the patient’s complaints.”  In assessing posterior capsular restrictions of the shoulder, we must be sure to perform the technique correctly.  Reinold (2015) discussed the importance of knowing anatomy of the shoulder and appreciating the need to angle the posterior glide laterally to avoid hitting the posterior glenoid rim.  Performing a posterior glide in the sagittal plane (not angled) could result in one thinking the glenoid rim endfeel is posterior capsule tightness.

In summary, the convex-concave rule has merit and is a good starting point.  A thorough assessment of arthrokinematics and osteokinematics are prudent to determine the course of intervention.


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