SHOULDER PAIN  - 1

A VERY COMMON CONDITION OF SHOULDER PAIN IDENTIFIED WITH ITS MORPHOLOGY.

OUR COMMONEST WAY TO DIAGNOSE SHOULDER PAIN IS TO IDENDIFY FAULTY STRUCTURE LIKE TENDONS, MUSCLES,BURSA. DIAGNOSIS IS WRITTEN IN FORM OF  TENDINITIS, ROTATOR CUFF INJURY (TENDINITIS) BURSITIS,IMPINGMENT,THORACIC OUT LET SYNDROME,ANTERIOR SCALNAE SYNDROME

THESE STRUCTURES ARE TREATED VIA, REST TO PART,NSAID (ANTI INFLAMMETRY MEDICINE) AND PHYSIOTHERAPY MODALITIES.LATER ON HYPOMOBILITY AND STRENGTH OF MUSCULAR ELEMENTS ARE RETRIEVED BY MOBILISATION AND EXERCISES.

MY WAY OF ANALYSIS IS BIT DIFFERENT AND VERY EFFECTIVE.SINCE I AM THE WITNESS OF PREVIOUS AND PRESENT CONCEPT THEREFORE I CAN VISUALISED THE DIFFERENCE.

I DO NOT FIND THE STRUCTURE THAT CAUSE BUT I TRY TO FIND MOVEMENTS THAT PRODUCE PAIN .FAULTY MOVEMENTS PRODUCE PAIN

OUR WAY OF ASSESSMENT IS TO FIND OUT MAL-ALIGNED STATIC  CENTRE OF ROTATION(SCR) AND DYNAMIC CENTER OF ROTATION (DCR)-THESE ARE TWO MAIN THEME OF ASSESSMENT RIGHT ASSESSMENT PROVIDE RIGHT TREAMENT.

DOWNWARD ROTATED SHOULDER  

                                                                           


       

KEY FEATURE ARE

1.     ACROMIO- CLAVICULAR JOINT( AC JOINT ) IS DOWN TO STERNO-CLAVICULAR JOINT (SC JOINT)

2.     INFERIOR ANGLE OF SCAPULA SHIFTED MEDIALLY WHEN WE COMPARE WITH SUPERIOR ANGLE .IN NORMAL CONDITION SUPERIOR ANGLE & INFERIOR ANGLE ARE IN SAME LINE AND PARALLEL TO SPINE, HERE INFERIOR ANGLE IS CLOSE TO SPINE .

THIS IS STATIC- DE-ORINTATION OF SCAPULA. PATIENT NECK LOOKS LONG AND NECK TO SHOULDER SLOPE IS OBTUSE(ANGLE BETWEEN NECKLINE AND UPPER TRAP LINE IS MORE THAN 100◦

CONFERMATION –CORRECT THE POSITION OF SCAPULA(ABDUCT AND ELEVATE) WITH HAND AND MOVE THE SCAPULA IN UPWARD ROTATION IN LAST RANGE –PAIN INSTANLY REDUCED TO GREAT EXTENT. THIS CONFIRM THE DIAGNOSIS AS WELL AS PROVIDE THE TREATMENT

 

ANALYTICAL ANALYSIS

MUSCLE LENGTH

SUPRASPINATUS – SHORT

PECT. MINIOR – SHORT                                                      

RHOMBOID-SHORT

LEVATOR SCAPULA-SHORT

DELLOID – SHORT

UPPER TRAP- LONG

SERRATUS ANTERIOR- LONG

FAULTY PHYSIOLOGICAL MOVEMENTS DISTURB ACCECERRY JOINT MOVEMENTS TOO AND BECOME THE CAUSE OF PAIN DUE TO MICROTRAUMA TO MOVEING STRUCTURE OF JOINTIN THIS  CONDITION .

SCAPULAR UPWARD ROTATION –INSUFFICIENT. HOWEVER ROM IS FULL DUE TO EXTRA MOVEMENT IN G.H. JOINT .

IN-SUFFICIENT ACTION OF ROTATOR CUFF MUSCLE

DELTIOD PULL THE HUMERAL HEAD UPWAD AND KEEP ARM IN ABDUCTION –DELTIOD ACTION IS INSUFFICIENTLY ENCOUNTER BY RC MUSCLES-WITH THIS RESULT IN STANDING POSITION WEIGHT  OF ARM PUSH SCAPULA MEDIALLY AND(STATIC CENTER OF ROTATION)CHANGE.

LONG UPPER TRAP MUSCLE LOOSE TORQUE TO MOVE SCAPULA IN UPWARD ROTATION IN LAST PHASE OF ELEVATION.

ACTION OF UPPER TRAP   -                               

1.     ELEVATION OF SCAPULA

2.     UPWARD ROTATION OF SCAPULA

3.     ADDUCTION OF SCAPULA

ACTION OF LOWER TRAP-

1.     ROTATION SCAPULA UPWARD

2.     DEPRESS SCAPULA DOWNWARD

BOTH MUSCLE – SYNERGETIC IN UPWARD ROTATION AND ANTAGONESTIC IN ELEVATION-DEPRESSION

CHECK LIST

-UPWARD ROTATION IS  IN-ADEQUATE

-SCAPULA LATERAL BORDER DOESNOT REACH TO MID AXILLARY LEVEL

-SCAPULA ANGLE<60◦

-PASSIVE SUPPORT OF SCAPULA (ELEVATION OF SCAPULA WITH PALM) REDUCE SYMPTOMS AND CELVICAL ROTION ROM- INCREASE

-PUSHING SCAPULA IN ABDUCTION –A RESISTENCE IS FELT

 TREATMENT

STRENGTHENING OF LONG MUSCLE

1.     UPPER TRAP (ONLY ITS ELEVATION COMPONENT )SHOULDER SHRUGING- PRODUCE ADDUCTION SO AVOID SHOULDER SHRUGING

2.     STRENGTHING SERRATUS ANTERIOR IN ITS SHORT POSITION-

STRETCHING OF SHORT MUSCLES

LEVATOR SCAPULAE, RHOMBOIDS,DELTOID, SUPRASPINATUS AND LAT ROTATOR  BE STRETCH SLOWLY WITH LESS FORCE FOR HIGH DURATION(LONG TIME -LESS FORCE). ALL EXERCISE SHOULD BE DONE IN EXISTING RANGE.

PRECAUTION

1.     USE SLING TO SUPPORT ARM.

2.     USE ARM REST IN SITTING POSITION

3.     TRY TO KEEP SCAPULA IN ELEVATION AND ABDUCTEWD POSITION

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