Shoulder Lowe’s Orthopaedic Assessement In Massage Therapy

Question 1

Shoulder

Answer 1

-third most common musculoskeletal disorders after lumbar and cervical spine

-evaluation of pathologies begins with a fundamental understanding of the motions of the shoulder

-four articulations: scapulothoracic, sternoclavicular, acromioclavicular and glenohumeral

-most movement occurs at the glenohumeral joint with some contribution from the scapulothoracic

-glenohumeral joint has greatest range of motion of any joint

-motion at the sternoclavicular and acromioclavicular joints is minimal so are not calculated in clinical

-soft tissues play a critical role in maintaining joint integrity

-this places the shoulder at risk for soft-tissue injuries

-acute injuries result from blows to the shoulder, falling on an outstretched arm, or forceful movements that dislocate/sublux the joint

-chronic injuries result from the movement requirements in repetitive upper-extremity activities and when the joint held for prolonged periods in a position that impinges the soft tissues

Question 2

Movements and Motion Testing

Answer 2

1. Single-Plane Movements:

+ Glenohumeral joint: flexion, extension, medial and lateral rotation, abduction and adduction

-two accessory motions: horizontal abduction (horizontal extension) and horizontal adduction (horizontal flexion); start with the arm abducted to 90 degrees instead of in neutral position

+ Scapulothoracic articulation: elevation, depression, protraction, retraction and upward/downward
rotation

-a functional rather than anatomical joint; ROM values are not calculated, no joint capsule so no capsular pattern

-motion is important in evaluating certain shoulder disorders

• Glenohumeral joint:

-flexion and extension occur in the sagittal plane

flexion = 160-180°

extension = 60°

-medial and lateral rotation occurs in the transverse plane

medial rotation = 90

lateral rotation = 90

-abduction and adduction occur in the frontal plane

abduction = 180

adduction = 50-75

-horizontal adduction and abduction occur in the transverse plane no specific values given

Question 3

Scapulothoracic articulation: movements and motion testing

Answer 3

-elevation and depression occur in the frontal plane

elevation: superior movement of the scapula

depression: inferior movement of the scapula

-protraction and retraction occur in multiple planes

protraction: scapula moves in an anterior and lateral direction

retraction: scapula moves in a posterior medial direction

-upward and downward rotation occur in the frontal plane

upward rotation: associated with abduction; glenoid fossa rotates upward

downward rotation: associated with adduction; glenoid fossa rotates downward

Question 4

Capsular Patterns

Answer 4

-lateral rotation is limited first, abduction is limited next, medial rotation is last

Question 5

Range of Motion and Resistive Tests

Answer 5

• AROM: patient standing; abductors are engaged concentrically with abduction; eccentrically when returned to the body; concentric contraction of adductors requires a change in body position or in the way resistance is employed (resistance on the underside of arm)

-pain indicates either contractile or inert tissues

-ligamentous or capsular damage, soft-tissue impingement, muscle tightness, pain from nerve compression or tension, tendinosis or tendinitis, fibrous cysts or arthritis can prematurely limit movement

• PROM: patient standing or supine to decrease muscular activity

-pain indicates inert tissues and stretched tissues at end range

-evaluates end feel; tissue stretch for all motions

flexion: soft;
extension: firm;
medial rotation: soft;
lateral rotation: firm
abduction: soft

Question 6

Resistive tests

Answer 6

MRT: pain when there is a mechanical disruption of tissue: one or more of the muscles and/or tendons
performing the action are involved

-palpation during MRT elicits more information if the test alone does not create pain or discomfort

-weakness can be evident: lack of use, fatigue, reflex muscular inhibition, or neurological pathology

Resisted Flexion: standing/seated, shoulder partially flexed, holds arm in flexed position as therapist attempts to pull it down into extension (place hand above patient’s elbow so flexors are not recruited)

Resisted Extension: standing/seated, arm slightly extended, holds arm in extended position as therapist attempts to push it into flexion (place hand above patient’s elbow so extensors are not recruited)

Resisted Medial Rotation: standing/seated, elbow flexed to 90, holds arm stationary as therapist uses one hand to hold patient’s elbow close to the torso and attempts to pull the forearm into lateral rotation with the other hand

Resisted Lateral Rotation: standing/seated, elbow flexed to 90, holds arm stationary as therapist uses one hand to hold patient’s elbow close to the torso and attempts to push the forearm into medial rotation with the other hand

Resisted Abduction: standing/seated, arm partially abducted, holds arm in position while therapist attempts to push it back to patient’s torso; apply pressure just above elbow

Resisted Adduction: standing/seated, arm partially abducted, holds arm in position while therapist attempts to pull it into further abduction; apply pressure just above elbow

Resisted Horizontal Adduction: standing/sitting, arm abducted to 90, therapist has one hand on back of patient’s opposite shoulder for stabilization, other hand on patient’s arm above elbow; patient holds position as therapist attempts to pull arm into horizontal abduction

Resisted Horizontal Abduction: standing/sitting, arm abducted to 90, therapist has one hand on back of patient’s opposite shoulder for stabilization, other hand on patient’s arm above elbow; patient holds position as therapist attempts to push arm into horizontal adduction