The Shoulder

The Shoulder

I taught over Columbus Day Weekend at a reunion conference at UNECOM and covered the shoulder. So, here are the highlights of my presentation.  First of all the shoulder is the most mobile joint of the body with a very shallow glenohumeral joint that is made deeper by the labrum.  The rotator cuff consisting of the SITS muscles:  Subscapularis, Infraspinatus, Teres minor and Supraspinatus are what add stability to this joint and can be injured; but, what typically sets a person up for injury to the shoulder joint itself is dysfunction of the scapulothoracic pseudo-joint.  Examining and treating somatic dysfunction of the cervical spine, thoracic spine, ribs and scapulothoracic joint are the key to solving any shoulder problem that has not yet become a true tear in the rotator cuff or labrum.

Remember that only 0-60 degrees of shoulder abduction occurs solely at the glenohumeral joint, 60-150 degrees then occurs at the scapulothoracic joint and the remaining 20-30 degrees of shoulder abduction occurs by the thoracic spine leaning to the contralateral side.  This emphasizes that treating the somatic dysfunction in all of these areas is imperative to optimizing healing and function of the shoulder joint.

One of my favorite techniques to engage the myofascial tissues of the rotator cuff and the scapulothoracic joint is to have the patient sit at the end of the treatment table.  I then stand on the side of the patient facing the shoulder I am going to treat.  I then place my thumbs up into the axillary fold with one thumb engaging the subscapularis between the scapula and the ribcage and the other thumb engaging the tissues of the anterior axillary fold.  The patient’s elbow is bent and their forearm rests relaxed on my forearm.  I then have the patient take a deep breath and when they exhale they lean their body weight toward me onto my hands.  As they lean their body weight toward me, my thumbs penetrate deeper and deeper into the myofascial tissues of the axillary fold/shoulder girdle.  I make a point to focus my engagement/penetration into the most hypertonic areas and have the patient keep breathing and leaning more and more onto my hands with each subsequent breath.

One thing to know is that this will not be your patient’s favorite treatment because it hurts as you engage the hypertonic myofascial tissues; but, you will find that the tissues respond pretty quickly to this engagement and start to unwind and release within moments.  I would categorize this as a myofascial release technique for the shoulder girdle.  I have had patients with limitation in their shoulder abduction that do not have any red flags for a significant rotator cuff or labral tear have complete resolution of their shoulder abduction after this treatment.  Try this with your next patient with shoulder or thoracic pain.