Approach to
Shoulder
Injuries
Review of Anatomy
Muscles related to front of the
shoulder pain
Infraspinatus
• Pain in this muscle creates an inability
to reach behind to a back pocket or to
bra hooks , and in front to comb the
hair or brush the teeth
• Corrective actions : pillows , avoid
abitual sustained repetitive motion
(putting on curlers)
Deltoid
• Pain in this muscle creates a dull ache
• Trigger points in this muscle may result
from impact, trauma ,and sports,or
from over exultion
• Posterior Deltoid Tps painfully weaken
abduction of the internally rotated arm
• Corrective actions : Include elimination
of perpetuating mechanical
stresses,and a program of daily
Supraspinatus
�Subdeltoid Bursitis
Mimicker�
• Activation of TPs is likely to result when
heavy objects are carried with the arm
hanging down , or when lifted above
shoulder height
• Corrective Action : include the
avoidance of continued overload of the
muscle ,and the use of a stretch
exercise at home while seated under a
hot shower
Scalene Muscles
典he Entrappers�
• Activation of trigger points: occurs by
pulling , lifting , and tugging ; by over
use of these accessory inspiratory
muscles as in coughing and by chronic
muscle strain due to a tilted shouldergirdle axis caused by body asymmetry
with a short leg or small half-pelvis
• Corrective actions: essential for
continued relief and require daily
Pec Mayor
撤oor posture and heart
attack�
• Patient examination reveals shortening
of the Pectoralis mayor muscle by active
or latent TPs which pulls the shoulder
forward to produce a stooped,roundshouldered posture
• Corrective Actions: convincing the
patients(when true) that the myofascial
chest pain is a treatable pain of skeletal
muscle rather then of cardiac origin.
Subscapularis
� Frozen shoulder�
• Patient examination identifies
involvement of this muscle by the
marked reciprocal limitation of
abduction and external rotation of the
arm at the shoulder.
• The humeral attachment of the muscle
is tender to palpation.
• Corrective action include: avoidance or
prolonged shortening of the muscle
Initial Assessment
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Twelve Steps
1. Client History
2. Assess Active Range of Motion
3.Assess Passive Range of Motion
4.Assess Resisted Range of Motion
5. Area Preparation
6. Myofascial Release
Initial Assessment cont.
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7. Trigger Point Therapy
8. Cross Fiber or Multidirectional Friction
9. Pain Free Movement
10. Eccentric Scar Tissue Alignment
11. Stretching
12. Strengthening
The Physiological Factors:
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1.) Ischemia
2.) Trigger Points
3.) Nerve Entrapment
4.) Posture & Biomechanical
Dysfunctions
• 5.) Nutrition
• 6.) Emotional Well Being
Acute Injury
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Rest
Ice
Compress
Elevate
Chronic Pain
• Is considered to be that which remains
at least three weeks after injury
Four Steps of Soft Tissue
Therapy(In order listed)
• 1.) Decrease the spasm and hyper
contraction of the soft tissue with
neuromuscular therapy
• 2.) Restore flexibility by appropriate
•
stretching
Four Steps of Soft Tissue
Therapy cont.
NMT• Powerful tool � but commitment
to
• change in lifestyle and self-care
• will be necessary for long lasting
• results
Common features of Trigger
Points
• Primary activating factors
Secondary Activating
Factors
Active and latent features
• Trigger points may be either active or
latent
Activation of Trigger Points
Evaluating for the presence of
trigger points
Other Common Observations
Treatment Options
Which Method was more
effective
Applications of NMT
The order of the routines
••• last
Superficial to deep
Gliding strokes
Static pressure and T.P. don�t
Moderate Gliding Speed:
• - Assures proper palpation of tissues
How long to apply pressure:
• - Will vary, should soften 8-12 sec.
Amount of pressure
••• -
Can vary greatly
Physical make up
Scale 1-10 (5 � 6 � 7 ) ideal
Communication during the
therapy
•Pt. Active involvement in
treatment.
•Q: Is it tender?
•Q: Does it refer
• Q: Is it responding
The Laws
Specific Shoulder Dysfunction
• Capulitis
• Supraspinatus Tendinitis
• Bicipital Tendinitis
Capsulitis
• Generalized pain rather than localized
• Frozen shoulder
Supraspinatus Tendinitis
• - Associated with subdeltoid or
acromeal bursites or rotation cuff
dysfunction
Bicipital Tendinitis
• Symptoms similar to superaspinatus
tendonitis location differs
• (Lipmans test)