Elevated And Slumped Shoulders

Question 1

1. Elevated Shoulder:

Structural and postural deviations

Answer 1

-postural distortion stemming from hypertonicity in the shoulder and neck muscles; may produce aching pain and adversely affect shoulder mechanics

Characteristics: unilateral or bilateral; chronic tightness in levator scapulae or upper trapezius muscles; can be congenital; usually results from chronic poor postural habits; can be from chronic psychological stress which can manifest in particular holding patterns; trigger points often develop in these muscles

History: headache, shoulder or neck pain; hypertonicity may produce aching pain; ask about postural habits or ergonomic factors that might create tension

Observation: elevated shoulders) in anterior or posterior view

Palpation: upper trapezius and levator scapulae muscles tight, may be trigger points

• Range of Motion and Resistance Testing:

AROM: active elevation may be limited on affected side due to hypertonicity, restriction in lateral
flexion of neck to opposite side likely due to tightness

PROM: may be limitation in passive shoulder depression due to muscle tightness

MRT: resisted shoulder elevation may elicit pain from hypertonicity or trigger points

Suggestions for Treatment: postural retraining and neuromuscular re-education, repetitive dysfunctional patterns must be offset by repeated corrections; massage and stretching to reduce hypertonicity and trigger points in levator scapulae and upper trapezius

Question 2

2. Slumped Shoulders:

Structural and postural deviation

Answer 2

-frequently coexist with upper thoracic kyphosis and forward head posture; common with sedentary lifestyle and poor posture, can lead to shoulder and upper thoracic vertebrae pathologies

Characteristics: postural balance is dependent on equalized tension between anterior and posterior shoulder girdle muscles; when the medial rotators of the shoulder are hypertonic, they cause an increase in medial rotation of the humerus and protraction of the scapulae; rhomboids can become weakened from reciprocal inhibition

-upper crossed syndrome can occur

-medial rotators of shoulder are shortened, muscular fatigue and trigger points in upper back, over-lengthened rhomboids and middle trapezius causes pain similar to the pain of hypertonicity

-often result from chronic postural distortions; work with arms directly in front or sit for prolonged periods in poor postures

-can result from osteoporosis or other vertebral degeneration

History: may report pain in rhomboids and middle trapezius due to muscular fatigue and/or trigger points, rarely pain in internal rotators except with palpation; ask about postural stress and osteoporosis or vertebral degeneration

Observation: lateral view, centre line of glenohumeral joint is forward of centre line of gravity, forward head posture, upper thoracic kyphosis often, often bilateral

Palpation: upper chest muscles hypertonic and tender, rhomboids and mid-trapezius are tender due to muscle fatigue and trigger points

Range of Motion and Resistance Testing:

AROM: limitation in lateral rotation due to hypertonicity in pectoralis major, restriction to active
retraction of scapulae due to muscle tightness

PROM: as with AROM

MRT: pain, discomfort or muscle weakness is not likely

Suggestions for Treatment: focus on hypertonic muscles (pectoral major, anterior deltoids, latissimus dorsi and other medial shoulder rotators); fascial elongation and deep longitudinal stripping; upper back muscles treated for fatigue and tension; repetitive dysfunctional patterns should be offset by repeated corrections to change faulty biomechanics; postural retraining and neuromuscular re-education, changes in ergonomics