Shoulder Lecture

1. Shoulder Mobilization Case
Study
Proximal Humeral Fracture

2. History
•61 year old male
•Fractured the greater tuberosity of the right
shoulder eight weeks ago
•Partially tore the rotator cuff muscle of the
same shoulder.
•Patient was immobilized in a sling for eight
weeks.

3. Clinical Presentation
•Sever limitation of right shoulder motions
•Demonstrates a capsular pattern
–External rotation, abduction , medial rotation
•Complains on a dull constant ache within the shoulder
at rest. Rating the resting pain as a 6/10 on the pain
scale.
•Experiences sharp pains with any motion of the
shoulder . Pain is rated as a 8/10.
•X-rays and MRI indicates that the fracture is healed
and the rotator cuff is partially healed.

4. Physical Therapy Referral
•Restore motion and normal
strength to the right shoulder

5. Clinical Considerations
•Patient has moderate to sever pain with
any movement.
•Shoulder restriction is due primarily to
capsular and muscle shortening around
the fracture site.
•Muscular strength of the right shoulder
complex is weak due to the prolong
immobilization.

6. Treatment Plan
•Modalities
•Mobilization techniques
•Strengthening exercises

7. Mobilization
•Joints to be mobilized
–Glenohumeral
–Sternoclaviclar
–Acromclavical
–Scapula
•Potential muscled that are
shorten.
–Subscapularis
–Pectoral major & minor
–Infaspinatus & teres minor
–Lat
–Rhomboids
–Serrtaus
–Upper mid and lower trap

8. Goal
Increase shoulder glenohumeral
motion without exacerbation of pain.

9. Concepts To Remember In The
Glenohumeral Joint
•Osteokinematic : There is 3 degrees of freedom
–Flexion/Extension, ABd /ADd, Internal/External Rot.
•Articulator surface anatomy
–Concave glenoid & convex humerus
–Loose pack position 20 degrees scapulohumeral
abduction with 30 degrees elevation in the scapular
plane.

10. Concepts To Remember In The
Shoulder Complex Joint
•Accessory (Component) Motions
–Arthokinematic movements that must occur
in order for normal osteokinematic
movement to take place
•Eg. Inferior Glide
•Joint Play Motion
–Those accessory that can be produced
passively at a joint but not actively.
•Eg. Lateral Distraction

11. Physiological Movements
Refer to Matiland CD

12. Shoulder Flexion
•Glenohumeral
–Lateral distaction
–Inferior glide
–Posteior glide
•Sternoclavicular
–Inferior gilde
–Anterior glide
•Scapula
–Distraction
•Upward rotation
•Elevation

13. Scapluar Plane Oscillations
•General technique
–Introductory
–Pain
–Lubication of tissues

14. Glenohumeral Lateral Distraction
•Often one of the first
technique to use
•Good for general
capsular tightness
•Pain control

15. Inferior Glide In Loose Pack
•For restriction in
flexion and abduction
•Used to decreased pain
–with grade I & II
oscillation

16. Inferior Glide At 90º of
Abduction
•Increase mid-range
–flexion and abduction

17. Anterior Glide In Loose Pack
•The primary tissue
affect by this
technique is the
anterior capsular
region

18. Posterior Glide In Loose Pack
Matiland Technique
•Indication for
posterior capsular
tightness
•Used in the early
phases of the rehab
to began
•To increase internal
rotation

19. Posterior Glide At 90º Abduction
•Posterior Glide at 90
degrees abduction
•Increase flexion and
internal rotation

20. Posterior Glide in Flexion
•Advance technique
that gives a strong
localized stretch to
posterior capsule

21. Sternoclavicluar Inferior Glide
•Used to improve
component motion
for shoulder flexion.

22. Anterior & Posterior Glide of AC
Joint
•Assist in improving
shoulder flexion
•Used to decreased
joint pain in the AC
joint

23. Scapula Mobilizations
•The purpose of these
techniques is to increase
range of motion in
scapular:
–Superior glide
–Inferior glide
–Medial rotation
–Lateral rotation

24. Advance Soft Tissue Stretching
Latissmus Dorsi
•Patient supine
•Therapist at the head of patient
•One hand grips medial side of
patient hand just above elbow
and move it into flexion while
laterally rotating the shoulder
•The other hand and forearm
stabilizes the lower thorax
•Using the grip begin to stretch
into flex and lateral rotation

25. Advance Soft Tissue Stretching
Pectoralis Major
•Patient supine
•Therapist using both
hands grips the medial
side of the patient’s
elbow and flexs and
laterally rotate the
arms
•Placing a stretch on
the pectoral muscles

26. Subscapularis Stretch End Range

27. End Range Internal Rotation
•Use graded
oscillations
•This technique may
also be performed in
prone