The Shoulder Girdle This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. Search PubMed for more abstracts on this topic.
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The Patient's Guide to the Shoulder
Conditions That Respond Well Alternative Medicine Approaches to Disease
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The Shoulder Girdle
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Primary Shoulder Information
Shoulder Girdle Trauma
Rehabilitation Monograph Series ~ Chapter 16
By Richard C. Schafer, D.C., FICC and the ACAPress
The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.
Rehabilitation Monograph Series ~ Chapter 8
By Richard C. Schafer, D.C., FICC and the ACAPress
The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur.
Rehabilitation Monograph Series ~ Chapter 2
By Richard C. Schafer, D.C., FICC and the ACAPress
Without a doubt, no other health-care approach equals the efficacy of chiropractic in the general field of conservative neuromusculoskeletal rehabilitation. For many centuries, therapeutic rehabilitation was a product of personal experience passed on from clinician to clinician. In the last 20 years, however, it has become an applied science. In its application, of course, much empiricism remains that can be called an intuitive art --and this is true for all forms of professional health care.
This is a nice little Acrobat exam form from ProHealth
Shoulder Articles
Manipulative Therapy for Shoulder Pain and Disorders:
Expansion of a Systematic Review
J Manipulative Physiol Ther 2011 (Jun); 34 (5): 314–346
This study found a level of B or fair evidence for manual and manipulative therapy (MMT) of the shoulder, shoulder girdle, and/or full kinetic chain (FKC) combined with multimodal or exercise therapy for rotator cuff injuries disease or disorders (RCIDs). There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shoulder complaints, dysfunction, disorders and/or pain (SCDP). There is a fair (B) level of evidence for MMT with exercise that included proprioceptive retraining as helpful for frozen shoulder (FS) or adhesive capsulitis. There was a fair level of evidence (B) for MMT using soft tissue or myofascial treatments for soft tissue disorders (ST) of the shoulder. There is a limited level of evidence (C) for cervical lateral glide mobilization (CLGM) and/or HVLA manipulation with soft tissue release and exercise in the treatment of minor neurogenic shoulder pain (NSP). There is an insufficient level of evidence (I) for MMT with or without exercise or multimodal therapy in the treatment of OA of the shoulder. In particular, MMT must be combined, when safe, appropriate, and including no contraindications, with commonly indicated exercise or rehabilitative therapy, as it remains the standard care. For clinicians, however, this study is intended to guide them in the appropriate use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of shoulder complaints in the context of the entire hierarchy of available evidence.
J Manipulative Physiol Ther 2010 (Feb); 33 (2): 96–101
The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors “shoulder pain” and “neck pain” reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck” (95% CI, 0.2-1.3) statistically favored the intervention group. Manipulative therapy, in addition to usual care by the general practitioner, diminishes the severity of the pain in the shoulder and neck and improves the mobility of the shoulder and the cervicothoracic spine.
A Four Patient Case Series
Chiropractic & Osteopathy 2005 (Sep 16); 13 (1): 20 ~ FULL TEXT
The patient underwent a multimodal treatment protocol including soft tissue therapy, phonophoresis, diversified manipulation; and rotator cuff and shoulder girdle muscle exercises. Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities.
Physician and Sportsmedicine 2005 (Sep); 33 (9)
Shoulder pain resulting from glenohumeral instability is common among competitive swimmers. The biomechanics inherent to swimming promote muscular imbalances that stress the capsuloligamentous structures and contribute to shoulder instability. Most swimmers respond favorably to conservative treatment of rest and rehabilitation, while a small percentage may ultimately require surgical intervention. Swimmers who respond well to rehabilitation have a better prognosis for a successful return to swimming than those who require surgery. Overall, education in proper stroke and training techniques can minimize the likelihood that a competitive swimmer will experience disabling shoulder pain.
Rotator Cuff Impingement
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 580-590
Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities.
Ann Intern Med 2004 (Sep 21); 141 (6): 432-439
Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
A Longitudinal Study in Young Adults
SPINE (Phila Pa 1976) 2004 (Aug 1); 29 (15): 1662–1669
This random sample of 826 high school students was investigated when they were 15 to 18 years old, and again at 22 to 25 years of age, to estimate the prevalence and incidence of neck and shoulder pain in young adults, and to identify the associated and predictive factors of neck and shoulder pain based on a 7-year follow-up. In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. In young adults, the incidence of neck and shoulder pain is high, and the associated factors of neck and shoulder pain are already multifactorial in a young population.
Kim Christensen,DC,DACRB,CCSP,CSCS
Many of the shoulder problems that chiropractors see involve one or more forms of rotator mechanism dysfunction. This chronic biomechanical continuum usually begins with dysfunction of the rotator cuff muscles and progresses to rotator cuff syndrome; supraspinatus tendinitis; impingement syndrome; subdeltoid and subacromial bursitis; calcific shoulder bursitis; and even most cases of frozen shoulder and bicipital tendinitis. In such cases, there is no direct, acute injury.
Kim Christensen,DC,DACRB,CCSP,CSCS
There is now a wealth of data that supports the value of resistance exercise in the geriatric population. Improvements are seen in weight and body composition, decreased falls/improved balance, better psychological health, less frailty, and improved function. With exercise, the resting blood pressure lowers and there is a reduction in the risk of all-cause mortality.3 These benefits overwhelm the few detrimental concerns, and encourage us to recommend resistance exercise to older patients who need upper extremity rehab.
Craig Liebenson, DC
During activities involving lifting of the arms, fixation of the scapulae is the key. Upper trapezius and levator scapulae fix the scapulae from above, while the lower trapezius and serratus anterior do so from below. The upper fixators attach to the cervical spine while the lower ones attach to the thoracic spine. Since the upper fixators are usually overactive and the lower fixators inhibited, overstrain of the cervical spine during carrying or reaching activities is common.
J Manipulative Physiol Ther 2001 (Jul); 24 (6): 425–430
The patient had undergone strength training for rehabilitation after each of the previous two shoulder operations and had very strong rotator cuff and scapular musculature. Proprioceptive testing revealed a poor response in the left shoulder compared with the right shoulder. Two subjective outcome measures were used to determine the effectiveness of the treatment protocol in reducing the symptoms of recurrent shoulder instability. Much of the treatment focused on proprioceptive training, soft tissue mobilization, and improving joint function.
Physician and Sportsmedicine 2004 (Nov); 32 (11)
An otherwise healthy 47-year-old man reported a history of right shoulder pain subsequent to an injury he sustained several months earlier while boating. The patient recalled trying to lift a heavy object out of the water when his right arm was forcibly externally rotated. The patient related that his arm was sore for several days after the injury, but his pain receded and became manageable. He did not seek medical care acutely. Months later, when he did seek care, he said that he had lost overall power in his shoulder and had generalized shoulder pain with activity. Furthermore, he could not tuck his shirt into his pants with his right arm.
Physician and Sportsmedicine 2002 (Dec); 30 (12)
A fall onto an outstretched arm or a collision on the playing field often leads to an acute anterior shoulder dislocation for high school- and college-age athletes. The diagnosis is usually made by history and physical exam. The angle of impact is an important diagnostic clue. If no neurologic contraindications or signs of acute fracture are seen, radiographs are unnecessary, and early reduction before the onset of muscle spasm is essential. Recent advances in arthroscopic techniques have dramatically reduced the high incidence of recurrent instability in young elite athletes, though nonoperative management with immobilization is still an excellent option.
J Manipulative Physiol Ther 1995 (Feb); 18 (2): 105–115
The patient's shoulder was conservatively managed with chiropractic adjustments to the affected shoulder joint, as well as to the cervicothoracic spine. Treatment consisted of mechanical force, manually assisted short lever chiropractic adjustments, delivered via an Activator Adjusting Instrument. Successful resolution of the presenting symptomatology was achieved.
Important Treatment and Educational Considerations
While watching the golf swing, it's obvious that shoulder muscles are used to create a powerful swing. Not so obvious are the details of shoulder muscle activity during the swing. Fortunately, a handful of electromyographic studies have given us a better understanding of shoulder muscle function during the golf swing.3,4,5 These studies demonstrate that rotator cuff muscles (particularly the subscapularis), the latissimus dorsi and pectoralis major are highly active during the golf swing.
Today's Chiropractic 2004 (May)
This article reviews the biomechanical structure and function of the glenohumeral joint, the typical mechanisms of injury, and then reviews injury prevention, exercises, and rehabilitative strategies.
The exercises described below are to help you strengthen the muscles in your shoulder (especially the muscles of the rotator cuff--the part that helps circular motion). These exercises should not cause you pain. If the exercise hurts, stop exercising. Start again with a lighter weight.
Thomas Souza,DC, DACBSP
The “Patient's Guide” to the Shoulder
Please NOTE that this remarkable series of articles is provided by surgeons. I only list them because of their pictures and anatomical discussions. The recommendations these articles make regarding drug use and surgical interventions run counter to the conservative approach provided by a rehabilitation-oriented chiropractor.
If you receive an error when trying to open one of these pages, please go to this website: http://www.eorthopod.com/, and select SHOULDER from the left-hand topics list, and then "click" on the article title, as listed below, from the displayed list.
The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems. Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured. The deepest layer of the shoulder includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.
A shoulder separation is a fairly common injury, especially in certain sports. Most shoulder separations are actually injuries to the acromioclavicular (AC) joint. The AC joint is the connection between the scapula (shoulder blade) and the clavicle (collarbone). Shoulder dislocations and AC joint separations are often mistaken for each other. But they are very different injuries.
Adhesive capsulitis, also called frozen shoulder, is a painful condition. It results in a severe loss of motion in the shoulder. It may follow an injury, or it may arise gradually with no injury or warning.
Biceps tendonitis, also called bicipital tendonitis, is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities. Biceps tendonitis may develop gradually from the effects of wear and tear, or it can happen suddenly from a direct injury. The tendon may also become inflamed in response to other problems in the shoulder, such as rotator cuff tears, impingement, or instability (described below).
Many people refer to any pain in the shoulder as bursitis. The term bursitis really only means that the part of the shoulder called the bursa is inflamed. Tendonitis is when a tendon gets inflamed. This can be another source of pain in the shoulder. Many different problems can cause inflammation of the bursa or tendons. Impingement syndrome is one of those problems. Impingement syndrome occurs when the rotator cuff tendons rub against the roof of the shoulder, the acromion.
The rotator cuff tendons are key to the healthy functioning of the shoulder. They are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons is an especially painful injury. A torn rotator cuff creates a very weak shoulder. Most of the time patients with torn rotator cuffs are in late middle age. But rotator cuffs tears can happen at any age.
Thoracic Outlet Syndrome causes pain along the top of the clavicle and shoulder. The pain may spread along the inside edge of the arm. Occasionally pain spreads into the hand, mostly into the ring and pinky fingers. Numbness and tingling, called paresthesia, may accompany the pain, especially in the early hours of the morning before it's time to wake up. Symptoms tend to get worse when driving, lifting, carrying, and writing. The arms may also feel tired when held overhead, as when using a blow dryer. It may be harder to hold and grip things, and the hand may feel clumsy.
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