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Shoulder Pain

Shoulder Pain

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Shoulder Pain

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  1. Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine

  2. Evaluation of Shoulder • Glenohumeral Joint • Acromioclavicular Joint • Sternoclavicular Joint • T1-T4 • Ribs 1-4

  3. Patient abducts arms and extends pronated hands over head Negative Test Upper arms should touch ears Elbows straight. Forearms pronated. Back hands approximate equally.  Joints of shoulder, elbow, radioulnar, and wrist are normal. Positive Test Patient unable to bring forearms to ears, straighten elbows, or approximate back of wrists. Check shoulders, elbows, and wrists. Also check upper ribs and upper T-Spine. Upper Extremity Motion Test

  4. Upper Extremity Motion Test

  5. Rotator Cuff MusclesSITS Supraspinatus-abduction Infraspinatus-ext.rotation Teres Minor-ext. rotation Subscapularis-int. rotation

  6. External Rotation & ABduction Special TestsApley Scratch Test and Shoulder ROM Internal Rotation & ADduction Internal Rotation & ADduction

  7. Shoulder Range of Motion • Glenohumeral and Scapulothoracic Joint • ABduction • ADduction • Flexion • Extension • Internal Rotation • External Rotation 180º 30-45º 90º 45-50º 55º 40-45º

  8. Special TestsRotator Cuff Pathology Arm drop Test (Empty Can Test)

  9. Gradual loss of function Decreased ROM - Active and Passive External Rotation Internal Rotation ABduction Diffuse tenderness Inflammation Fibrous changes in periarticular soft tissue Decreased joint volume - confirmed by arthography Adhesive Capsulitis“frozen shoulder”

  10. Seven Stages of Spencer • Excellent way to examine shoulder while treating

  11. Seven Stages of Spencer • 1. Extension • 2. Flexion • 3. Circumduction with Compression • 4. Circumduction with Traction • 5. Abduction • 6. Internal Rotation • 7. Joint Pump

  12. Technique (Muscle Energy) • Contact usually over elbow, but you are moving humerus to muscular barrier • Patient instructed to move in opposite direction isometrically • D.O. offers counterforce (isometric) • Patient & D.O. stop. Wait for tissue to relax (2-3 sec) • Carefully take up slack to next barrier • Repeat until best motion (usually 3 times)

  13. Stage 1 - Extension • Cup cephalad hand over clavicle and scapula • Flex elbow and carry humerus into extension to restrictive barrier • Apply muscle energy activation (patient flexes against you while D.O. offers counterforce) On relaxation, carry humerus to further extension

  14. Stage 2 - Flexion • Caudad hand stabilizes clavicle and scapula • Flex humerus to restrictive barrier should have 180° arc motion • Apply M.E. to active (patient attempts to extend shoulder against counterforce) • Relaxation (wait 2-3 seconds) • Carry shoulder in flexion to new barrier • Repeat 2-3 times as needed

  15. Stage 3 – Circumduction with Compression • Cephalad hand cups clavicle and scapula to stabilize • Flex elbow and abduct humerus to 90° • Compress gently to seat head of humerus in glenoid fossa • Circumduct elbow clockwise and counter-clockwise in a cone shape • Any areas of resistance-modify elbow pressure and change circumference of cone

  16. Stage 4 – Circumduction with Traction • Cephalad hand cups clavicle and scapula to stabilize • Grasp wrist and apply traction • Circumduct arm in cone-like fashion both clockwise and counter-clockwise • Any areas of resistance, modify the arm traction and/or change circumference of the cone

  17. Stage 5 - Abduction • Cephalad hand continues to cup clavicle and scapula to stabilize • Patient flexed at elbow • Adduct humerus to restrictive barrier • Apply muscle energy activation (patient adducts against D.O.) • On relaxation (wait 2-3 seconds), carry to new barrier

  18. Stage 6 – Internal Rotation • Cephalad hand cups clavicle and scapula • Place patient’s hand behind L/S area • Internally rotate humerus by moving elbow anteriorly • Active muscle energy (patient externally rotates against resistance) • Have patient relax. Wait 2-3 seconds. Internally rotate to new barrier

  19. Stage 7 – Joint Pump • Extend patient’s elbow • Abduct patient’s humerus • Place patient’s hand on your shoulder • Place your hands and fingers over humeral head • Apply caudal force with a scooping pumping action

  20. Seven Stages of Spencer • 1. Extension • 2. Flexion • 3. Circumduction with Compression • 4. Circumduction with Traction • 5. Abduction • 6. Internal Rotation • 7. Joint Pump