OMM approach to the shoulder

Question 1

scapular lift - purpose

Answer 1

1. improve circulation to muscles of shoulder

2. releases scapular splinting due to tightness of rhomboids

Question 2

scapular lift - technique

Answer 2

1. physician’s caudad hand contacts medial border of scapula and attempts to lift scapula toward ceiling
2. cephalad hand is used to depress shoulder to further wing scapula
3. as patient inhales, physician lifts scapula toward ceiling
4. as patient exhales, physician holds scapula in position
5. repeat to 4th barrier

Question 3

shoulder mobilization - purpose

Answer 3

1. treat scapulothoracic joint

2. helps with mobilizing the SCJ / ACJ

Question 4

shoulder mobilization - technique

Answer 4

1. patient lies on side with elbow and arm in slight internal rotation with the arm flexed behind back
2. physician’s forearm and body stabilizes patient’s forearm, upper arm, shoulder
3. physician’s hands are clasped together, cupping the shoulder
4. UE and shoulder girdle mobilized in all directions, emphasizing SC/AC and SCJ mobilization

GHJ is NOT moved - primary treatment is for SCJ

Question 5

internal rotators - evaluation

Answer 5

1. patient supine with arm in stop sign position
2. external rotation of shoulder
3. internal rotators are short is external rotation is less than 90 degrees

Question 6

internal rotators - treatment

Answer 6

muscle energy

Question 7

external rotators - evaluation

Answer 7

1. patient supine with arm at 90 degrees pointing down
2. internal rotation of shoulder
3. external rotators are short is internal rotation is less than 90 degrees

Question 8

external rotators - treatment

Answer 8

muscle energy

Question 9

SCJ - diagnosis

Answer 9

1. patient seated
2. physician stands behind patient
3. patient shrugs, physician palpates
4. patient brings arms forward and back (row boat)

Question 10

how is SCJ motion named?

Answer 10

by distal end of clavicle

Question 11

what is the most common SCJ diagnosis?

Answer 11

restricted ABduction and restricted flexion

Question 12

supine ME for restricted abduction at SCJ

Answer 12

1. patient supine
2. physician on affected side, monitoring SCJ
3. patient moved to edge of table and arm is extended off table
4. patient’s forearm between knees or grasps patient’s wrist
5. physician internally rotates and extends arm until motion is felt at SCJ
6. patient pushes up toward ceiling as physician isometrically resists their force
7. physician pushes down on the patient’s arm to take up the slack
8. repeat to 4th barrier
9. recheck

Question 13

supine ME for restricted flexion at SCJ

Answer 13

1. patient supine
2. physician stands on affected side
3. patient’s arm flexed to 90 and gently grasping physician’s shoulder
4. physician’s hand closest to patient monitors affected SCJ as other hand grasps medial border of patient’s scapula
5. physician pulls patient’s scapula anteriorly by straightening their posture
6. patient tries to bring shoulder down toward table as physician isometrically resists
7. recheck medial end of clavicles by horizontally flexing shoulder

Question 14

HVLA for ACJ/GHJ SD - treatment

Answer 14

1. patient seated
2. physician standing behind
3. physician’s arm draped in front and across patient’s chest, cupping flexed opposite elbow with both hands
4. patient’s forearm is supinated and arm is externally rotated and adducted
5. physician elevates patient’s elbow to raise the patient’s shoulder
6. physician asks if there is pain with compression
7. if no pain, patient turns head to opposite side, takes a breath, exhales
8. as patient exhales, physician takes up slack and exerts HVLA thrust superiorly

Question 15

mobilization of clavicle using its long axis

Answer 15

1. patient supine
2. physicians stands on affected side facing patient
3. physician’s hand grasps patient opposite elbow and internally rotates, abducts, and protracts the arm / shoulder
4. physician’s fingers placed behind patient’s clavicle
5. gentle and anterior and lateral traction is applied by the physician’s hand grabbing the arm as patient’s shoulder is abducted and adducted
6. to add another dimension to articulatory effect, physician may add internal and external rotation

Question 16

general mobilization LVMA of SC area

Answer 16

1. physician stands behind patient with opposite thumb in jugular notch and index and middle fingers below the clavicle to monitor motion at affected SCJ
2. using SCJ as fulcrum, patient’s affected side elbow is grasped and circumducted through full ROM
3. recheck SCJ

Question 17

general mobilization of AC area

Answer 17

1. patient seated
2. physician stands behind patient with opposite arm draped across patient’s chest
3. physician stabilizes affected clavicle just medial to affected AC articulation
4. physician grasps patient’s affected elbow and circumducts through full ROM
5. recheck