Common Shoulder Pathologies:
The 4 X 4 approach
The shoulder is truly an amazing structure. The longer you study the biomechanical components of the upper extremity, the more fascinating it becomes. Truly the most interesting aspect of the shoulder is the simple fact that is; what this structure lacks in stability it makes up in mobility. According to Robert A. Donatelli Ph.D., P.T., “the shoulder is capable of moving in over 16,000 positions, which can be differentiated by 1 degree in the normal person.”[1]
This sounds great in theory, but those 16,000 positions of movement are constantly compromised by our tedious activities of daily living that lead to numerous movement impairment syndromes. For the context of this text, movement impairment syndromes are defined as “localized painful conditions arising from irritation of myofascial, periarticular, or articular tissues. Their origin and perpetuation are the result of mechanical trauma, most often micro trauma.”[2] It is this constant bombardment of micro trauma that leads to some of our most common soft tissue shoulder pathologies.
In this topic of discussion we will look at two major categories of movement impairment syndromes of the upper extremity. The first category focuses on movement impairments of the scapulothoracic region and the second category focusing on the movement impairments of the glenohumeral region. Over the following 8 weeks we will discuss each movement impairment syndrome individually. Below you will see a breakdown of the two major categories with its corresponding movement impairment syndromes.
Movement Impairments of the Scapulothoracic Region
1. Scapular Downward Rotation Syndrome
2. Scapular Depression Syndrome
3. Scapular Abduction Syndrome
4. Scapular Winging Syndrome
Movement Impairments of the Glenohumeral Region
1. Humeral Anterior Glide Syndrome
2. Humeral Superior Glide Syndrome (Abduction)
3. Shoulder Medial Rotation Syndrome
4. Glenohumeral Hypomobility Syndrome
In our next series we will look at the first of eight series of conversations, in regards to movement impairment syndromes of the upper extremity. Scapular Downward Rotation Syndrome is composed of several of our classic shoulder pathologies: supraspinatus or rotator cuff tendinopathy and impingement, rotator cuff tears, thoracic outlet and neural entrapment, humeral subluxation, humeral instabilities, Neck Pain (including or not including radiating pain into the upper extremity), Pain in the levator scapula and upper trapezius muscle, and sternoclavicular joint pain.[3]
Tune in next week to continue this free educational lesson. If you are interested in attending any of our weekend workshops, feel free to check out our website http://www.massagesmart.com/, or tune in each week at http://massagesmart.blogspot.com/ . Don’t forget to subscribe to the feed that will automatically update you when I submit new educational blogs/articles.
Jeffery B. Wood LMT, COTA/L, B.S.
CEO Therapeutic Touch & Bodywork, Inc.
Lead Instructor Massage Smart: Education in Action
AMTA Heart of Florida Unit Chairman
W.T.I. Massage Therapy Director
*Please note, that this information is informative in nature. Massage Smart, nor any of its counterparts, intend to use this educational information to diagnose or perform soft tissue techniques outside the scope of practice of massage therapy.
[1] Donatelli, Robert A.: Physical Therapy of the Shoulder. 3rd Edition. Churchill Livingstone, Inc, Philadelphia, 1997.
[2] Sahrmann, Shirley A.: Diagnosis and Treatment of Movement Impairment Syndromes. Mosby, St. Louis, 2002.
[3] Sahrmann, Shirley A.: Diagnosis and Treatment of Movement Impairment Syndromes. Mosby, St. Louis, 2002.
