shoulder pain stuart williams, d.o. associate professor osteopathic manipulative medicine
TRANSCRIPT
![Page 1: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/1.jpg)
Shoulder Pain
Stuart Williams, D.O.Associate Professor
Osteopathic Manipulative Medicine
![Page 2: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/2.jpg)
Evaluation of Shoulder
Glenohumeral Joint Acromioclavicular Joint Sternoclavicular Joint T1-T4 Ribs 1-4
![Page 3: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/3.jpg)
Patient abducts arms and extends pronated hands over head
Negative Test Upper arms should touch ears Elbows straight. Forearms pronated. Back hands approximate equally. Joints of shoulder, elbow, radioulnar, and wrist
are normal. Positive Test
Patient unable to bring forearms to ears, straighten elbows, or approximate back of wrists.
Check shoulders, elbows, and wrists. Also check upper ribs and upper T-Spine.
Upper Extremity Motion Test
![Page 4: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/4.jpg)
Upper Extremity Motion Test
![Page 5: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/5.jpg)
Rotator Cuff MusclesSITS
Supraspinatus-abductionInfraspinatus-ext.rotationTeres Minor-ext. rotation
Subscapularis-int. rotation
![Page 6: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/6.jpg)
Special TestsApley Scratch Test and Shoulder ROM
External Rotation & ABduction
Internal Rotation & ADduction
Internal Rotation & ADduction
![Page 7: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/7.jpg)
Shoulder Range of Motion
Glenohumeral and Scapulothoracic Joint ABduction ADduction Flexion Extension Internal Rotation External Rotation
180º30-
45º90º45-
50º55º40-
45º
![Page 8: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/8.jpg)
Special TestsRotator Cuff Pathology
Arm drop Test (Empty Can Test)
![Page 9: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/9.jpg)
Adhesive Capsulitis“frozen shoulder”
Gradual loss of function Decreased ROM - Active and
Passive External Rotation Internal Rotation ABduction
Diffuse tenderness
Inflammation Fibrous changes in periarticular
soft tissue Decreased joint volume -
confirmed by arthography
![Page 10: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/10.jpg)
![Page 11: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/11.jpg)
Seven Stages of Spencer
Excellent way to examine shoulder while treating
![Page 12: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/12.jpg)
Seven Stages of Spencer
1. Extension 2. Flexion 3. Circumduction with Compression 4. Circumduction with Traction 5. Abduction 6. Internal Rotation 7. Joint Pump
![Page 13: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/13.jpg)
Technique (Muscle Energy) Contact usually over elbow, but you are
moving humerus to muscular barrier Patient instructed to move in opposite
direction isometrically D.O. offers counterforce (isometric) Patient & D.O. stop. Wait for tissue to
relax (2-3 sec) Carefully take up slack to next barrier Repeat until best motion (usually 3
times)
![Page 14: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/14.jpg)
Stage 1 - Extension Cup cephalad hand over clavicle
and scapula Flex elbow and carry humerus into
extension to restrictive barrier Apply muscle energy activation
(patient flexes against you while D.O. offers counterforce) On relaxation, carry humerus to further extension
![Page 15: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/15.jpg)
![Page 16: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/16.jpg)
Stage 2 - Flexion Caudad hand stabilizes clavicle and
scapula Flex humerus to restrictive barrier
should have 180° arc motion Apply M.E. to active (patient attempts to
extend shoulder against counterforce) Relaxation (wait 2-3 seconds) Carry shoulder in flexion to new barrier Repeat 2-3 times as needed
![Page 17: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/17.jpg)
![Page 18: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/18.jpg)
Stage 3 – Circumduction with Compression Cephalad hand cups clavicle and
scapula to stabilize Flex elbow and abduct humerus to 90° Compress gently to seat head of
humerus in glenoid fossa Circumduct elbow clockwise and
counter-clockwise in a cone shape Any areas of resistance-modify elbow
pressure and change circumference of cone
![Page 19: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/19.jpg)
![Page 20: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/20.jpg)
Stage 4 – Circumduction with Traction Cephalad hand cups clavicle and
scapula to stabilize Grasp wrist and apply traction Circumduct arm in cone-like
fashion both clockwise and counter-clockwise
Any areas of resistance, modify the arm traction and/or change circumference of the cone
![Page 21: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/21.jpg)
![Page 22: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/22.jpg)
Stage 5 - Abduction Cephalad hand continues to cup
clavicle and scapula to stabilize Patient flexed at elbow Adduct humerus to restrictive
barrier Apply muscle energy activation
(patient adducts against D.O.) On relaxation (wait 2-3 seconds),
carry to new barrier
![Page 23: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/23.jpg)
![Page 24: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/24.jpg)
Stage 6 – Internal Rotation Cephalad hand cups clavicle and
scapula Place patient’s hand behind L/S area Internally rotate humerus by moving
elbow anteriorly Active muscle energy (patient externally
rotates against resistance) Have patient relax. Wait 2-3 seconds.
Internally rotate to new barrier
![Page 25: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/25.jpg)
![Page 26: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/26.jpg)
Stage 7 – Joint Pump
Extend patient’s elbow Abduct patient’s humerus Place patient’s hand on your
shoulder Place your hands and fingers over
humeral head Apply caudal force with a scooping
pumping action
![Page 27: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/27.jpg)
![Page 28: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/28.jpg)
Seven Stages of Spencer
1. Extension 2. Flexion 3. Circumduction with Compression 4. Circumduction with Traction 5. Abduction 6. Internal Rotation 7. Joint Pump
![Page 29: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/29.jpg)
![Page 30: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/30.jpg)
![Page 31: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/31.jpg)
![Page 32: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/32.jpg)
![Page 33: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/33.jpg)
![Page 34: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/34.jpg)
![Page 35: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/35.jpg)
![Page 36: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/36.jpg)
![Page 37: Shoulder Pain Stuart Williams, D.O. Associate Professor Osteopathic Manipulative Medicine](https://reader036.vdocuments.us/reader036/viewer/2022062321/56649dc45503460f94ab73a2/html5/thumbnails/37.jpg)