00:00
The shoulder joint is the most
dynamic joint in our body.
00:04
Its flexibility allows us to
have the freedom
to perform many of our activities
of daily living.
00:11
Integration of osteopathic diagnosis
and treatment
could help to address any
sort of impairment
that our patients may present
with shoulder issues.
00:20
So let's take a closer look at the
shoulder joint itself.
00:23
The joint consists of the
articulation
between the head of
the humerus
and the glenoid fossa
of the scapula.
00:30
It is extremely mobile but
at the same time,
that makes it extremely unstable and
more suspect to injury.
00:36
It is a ball and socket joint
allowing for 180 degrees
of potential motion and
movement.
00:43
Our shoulder girdle consists
of three bones:
the clavicle, the humerus,
and the scapula.
00:49
There are three true
synovial joints:
the glenohumeral, the
sternoclavicular,
and the
acromioclavicular.
00:55
Then there are two functional
joints,
meaning that there's not an
actual articulation
of the bone to bone with a
joint in between,
but it's actually more of the
motion and movement
of the suprahumeral, meaning
the space
between the clavicle and the
head of the humerus,
and also the
scapulothoracic,
the functional joint
of the scapula
as it moves upon the
thoracic cage.
01:18
There are ligaments of the
glenohumeral joint
that thickens into a capsule
to try
to provide support and keep
that articulation
between the head of
the humerus
and the glenoid fossa
more secure.
01:29
The major support of
the capsule
are really the rotator
cuff muscles.
01:33
The clavicle is an important
bone to look at
because this is the only bone
that really stabilizes
the shoulder to the
midline skeleton.
01:42
The clavicle has two
different joints:
the acromioclavicular
at the distal end
and the sternoclavicular
in the proximal end.
01:51
Again, the two major
functions
is to prevent the glenoid from
turning anteriorly,
and also protects
different
neurovascular structures that
pass in the region.
02:01
Here's a closer look at
the acromioclavicular
and sternoclavicular
joints.
02:07
If we have any sort of somatic
dysfunctions
that restrict the motion
or movement
at the A-C or
S-C joints,
it could potentially impact
your shoulder mobility.
02:18
The scapula is located
posteriorly
along your thoracic
cage.
02:25
It is a flat bone and it has some
key important landmarks.
02:28
So you can note the spine of the
scapula posteriorly
where there are many
muscle attachments.
02:33
The acromion process is
the most distal
portion of that scapular
spine.
02:39
You have your coracoids process
that juts anteriorly
that you could find where the
pectoralis muscles attach.
02:45
Then you have your
glenoid fossa
where the articulation between
the humerus
and the glenoid
meet.
02:52
The humerus itself is the other side
of the shoulder joint.
02:56
You have an anatomical neck,
greater tuberosity there,
and also a lesser
tuberosity.
03:01
In between is a
groove
where the biceps tendon
runs through.
03:07
The rotator cuff muscles help to
stabilize the shoulder joint
and at the same time help to
move the shoulder joint.
03:14
So these four muscles are extremely
important to remember.
03:17
We have the supraspinatus
muscle
which helps with
shoulder abduction.
03:21
We have the infraspinatus and the
teres minor muscle
which helps with shoulder
external rotation.
03:27
Then you have your
subscapularis muscle
which helps with
internal rotation.
03:31
Again, these muscles help
to stabilize the joint
and also provide these motions
at the shoulder joint.
03:37
A way to remember these
muscles is SITS.
03:40
This is a mnemonic taking the first
letter of each muscle,
so the supraspinatus,
infraspinatus,
teres minor, and
subscapularis.
03:46
If you take the first letter of
each of these muscles,
it spells
out SITS.
03:50
So that's an easy way to
try to remember
your four rotator
cuff muscles.
03:55
For shoulder joint motion
and movement,
there is an association between the
humerus and the scapula.
04:03
For every 10 degrees of
humerus abduction,
there needs to be 5 degrees
of scapula abduction
because anatomically you cannot
abduct the humerus
without motion of
the scapula
coming out in
abduction also.
04:16
Otherwise, it would compress
the muscles
and the neurovascular structures
right above
this humerus in the
suprahumeral space.
04:25
Range of motion testing
of the shoulder,
we could motion test
the shoulder
in many different planes
of motion.
04:31
Again, the shoulder is the
most mobile joint.
04:34
So in the sagittal plane with
flexion and extension,
we should be able to flex the shoulder
about 180 degrees
and extend about 45
to 60 degrees.
04:42
In abduction and adduction in
the coronal plane,
we should be able to abduct
our shoulder
about 180 degrees and adduct
about 45 degrees.
04:52
Internal and external rotation
is a little bit harder
to measure in the
shoulder.
04:56
When we're measuring this motion
at transverse plane,
we could have the patient
flex their elbow
so that we could actually measure
the number of degrees
the shoulder is going
to turn.
05:06
In internal rotation,
if this is zero
with our elbows stabilized
next to our body,
we could internally rotate
our shoulder
and we could also externally
rotate our shoulder.
05:15
The key is to really stabilize
the elbow joint
so that you don't let
the elbow move.
05:20
Otherwise, you may get
a false reading
based on your
measurements.
05:25
The other way to measure
internal and external
rotation of the shoulder is to
bring the arm up
to 90 degrees and then
have the patient
slowly bring their arm,
shoulder
into internal rotation and
into external rotation.
05:36
Again, it's good to stabilize the
shoulder and the elbow
as you're performing these range
of motion testings.
05:43
If you have a restriction in
range of motion testing,
this will help you with
diagnosis
of a shoulder somatic
dysfunction.
05:51
Remember, somatic dysfunction is
a restriction of motion.
05:54
So when we find a restriction
of motion
in a particular plane, we're
going to name
that somatic dysfunction for
its freedom of ease.
06:03
You don't want to confuse
the diagnosis.
06:07
So what you're going
to do is
you're going to find a
restriction of motion.
06:10
Let's say my shoulder is
restricted in flexion.
06:14
I don't call it a shoulder flexion
somatic dysfunction
because somatic dysfunction
is always named
for its position
of ease.
06:21
What I'm going to call
it instead is
it is a right shoulder
restriction
or a right shoulder extension
somatic dysfunction,
naming it the opposite
direction.
06:32
These are the possible somatic dysfunctions
of the shoulder
based on the planes
of motion
and the motions that we
have at the shoulder.
06:41
You could have a flexion
or extension
somatic dysfunction in the
sagittal plane.
06:44
You could have an internal and
external rotation
somatic dysfunction in the
transverse plane.
06:48
And you could have an
abduction and adduction
somatic dysfunction in
the coronal plane.
06:53
Let's practice this
information.
06:55
We have a 35-year
old male,
comes in with right
shoulder pain
after painting the ceiling
yesterday.
07:00
On physical exam,
you note that
he could flex his right
shoulder 80 degrees
and his left shoulder
180 degrees.
07:06
What is the correct shoulder somatic
dysfunction diagnosis?
Here on motion testing, we note
that the left shoulder
has full range of motion
at 180 degrees
but the right shoulder is limited
at 80 degrees.
07:22
So the right shoulder is the
problem shoulder.
07:24
The problem is that there is
limited right shoulder flexion.
07:28
So the somatic dysfunction is to
call it for its freedom.
07:31
So this is a right shoulder extension
somatic dysfunction.