The Shoulder: Subscapularis Injuries. Presented by Dr. Ben Benjamin

Transcription

1 Debilitating Orthopedic Injury Sampler #3 The Shoulder: Subscapularis Injuries Presented by Dr. Ben Benjamin 1 Instructor: Ben Benjamin, Ph.D. 2 1

2 Instructor: Ben Benjamin, Ph.D. 3 Thank You 4 2

3 Webinar Goal Explore the assessment and treatment of one of the most common shoulder injuries. 5 Things to Keep in Mind 1. Do you know how much motion is possible in the gleno-humeral joint? 2. What is the primary muscle do you use to throw a ball? 3. What does a painful arc mean? 4. What do passive tests of the shoulder tell you? 5. Which rotator cuff muscle is the strongest? 6 3

4 Anatomy 7 Subscapularis Anatomy Subscapularis tendon Subscapularis muscle 8 4

5 Subscapularis Function Subscapularis tendon Subscapularis muscle 9 Subscapularis Tendon 10 5

6 Tenoperiosteal Junction Tenoperiosteal junction 11 Rotator Cuff Support Supraspinatus muscle Supraspinatus tendon Infraspinatus muscle Infraspinatus tendon Subscapularis tendon Subscapularis muscle Teres minor 12 6

7 Anatomy Drawing Watch the video at the end of the Webinar 13 Movement Anatomy Hand at your side, palm facing down. Bend elbow to 90 degrees, palm forward Bring hand to abdomen 14 7

8 Taking a History Which shoulder is it? And have you seen a doctor about it? 16 bds/shutterstock.com 8

9 2. Where does it hurt? Can you point to it? 17 Jacek Chabraszewski/Shutterstock.com 3. How long has it hurt? Korn/Shutterstock.com 18 9

10 4. How old are you? What precipitated the problem? Was there an accident? 20 Evgeny Murtola/Shutterstock.com 10

11 6. Can you sleep on the injured side at night? 21 Africa Studio/Shutterstock.com 7. Does the pain go below your elbow? 22 11

12 8. What daily movements hurt you? 23 Christo/Shutterstock.com 9. Is it getting better or worse? 24 Alice Day/Shutterstock.com 12

13 10. Are you on medication? 25 Assessment Theory 26 13

14 Assessment Tests and Indicators Resisted Tests Passive Tests Active Tests Major Indicator Auxiliary Indicator 27 Resisted Tests 28 14

15 Passive Tests 29 Active Test 30 15

16 Major Indicator Tells you the most important information: WHAT is injured 31 Auxiliary Indicator Tells you which part of the muscle-tendon unit is damaged 32 16

17 Assessment Tests for the Subscapularis 33 Resisted Medial Rotation 34 17

18 Passive Elevation 35 Passive Horizontal Adduction 36 18

19 Painful Arc 37 Why do we test in different positions? 38 19

20 Referred Pain 39 Four Rules of Referred Pain 1. Distal Reference 2. Doesn t cross the midline 3. Is referred in the dermatomes 4. The distance is proportional to the severity of the injury 40 20

21 Four Rules of Referred Pain Rule #1 Pain refers distally. 41 Four Rules of Referred Pain Rule #2. Pain does not cross the midline

22 Four Rules of Referred Pain Rule #3. Pain is referred within the dermatomes. 43 Four Rules of Referred Pain Rule #4. The distance the pain refers is directly proportional to the severity of the injury

23 Theory 45 Assessment Test Results for the Subscapularis MI: Resisted medial rotation is painful AUX: Passive elevation is sometimes painful AUX: Passive adduction is sometimes painful AUX: Painful arc is sometimes painful 46 23

24 How Does This Injury Occur? A fall onto the side of the shoulder Overuse Anterior shoulder dislocation Nautilus machine starting too far back 47 Which muscle throws a ball sidearm? Aspen Photo/Shutterstock.com 48 24

25 Which muscle throws a ball overhead? Aspen Photo/Shutterstock.com 49 Clinical Application How much motion is there in the shoulder joint 90 degrees 120 degrees 135 degrees 180 degrees 360 degrees 50 25

26 Tennis Forehand and Serve Maxisport / Shutterstock.com 51 Excessive Kyphotic Curve 52 DM7/Shutterstock.com 26

27 Why might this action cause pain? 53 Why might this action cause pain? Poulsons Photography/Shutterstock.com 54 27

28 Why might this action cause pain? Felix Mizioznikov/Shutterstock.com 55 Why might this action cause pain? 56 Robert Kneschke/Shutterstock.com 28

29 Why might this action cause pain? 57 Why might this action cause pain? Africa Studio/Shutterstock.com 58 29

30 Clinical Application 59 Clinical Application You suspect the person has a subscapularis injury because they report pain in the shoulder after hitting forehand while playing tennis for 15 minutes. However, when you test them in your office, instead of having pain on resisted medial rotation of the shoulder, they are just incredibly weak. Why is there no pain on the assessment test? What is happening? How would you further assess this injury? 60 30

31 Clinical Application Why is there no pain on the assessment test? 61 Clinical Application What is happening? 62 31

32 Clinical Application How would you further assess this injury? 63 Treatment 64 32

33 Myofascial Treatment Photos courtesy of Gregory Mayfield 65 Friction Therapy Watch the video at the end of the Webinar 66 33

34 Massage Valua Vitaly/Shutterstock.com 67 AIS: Stretching the Subscapularis Watch the video at the end of the Webinar 68 34

35 Self-Treatment: Tendon Injury Exercise Program 69 General Exercise Guidelines: This program must be done every day. It can be increased to twice a day after about two weeks. The client must feel some fatigue at the end phase of the exercises

36 General Exercise Guidelines: The five steps 1. Warm up 2-3 minutes move the relevant body part around. 71 General Exercise Guidelines: The five steps 2. Stretch affected area 5 times, seconds each time. Rest between stretches

37 General Exercise Guidelines: The five steps 3. Use a light weight to do 3 sets of 10 of the assigned exercise. Rest between each set of 10. Last set should cause slight fatigue. 73 General Exercise Guidelines: The five steps 4. Stretch 5 times for seconds

38 General Exercise Guidelines: The five steps 5. Apply ice or heat for 5-10 minutes. 75 General Exercise Guidelines: If the last ten repetitions do not cause any fatigue in the first session, add a pound the next day. Keep adding a pound per day each day until a sense of fatigue is present

39 General Exercise Guidelines: On the first day of the second week, increase the amount of weight to that which will cause slight fatigue in the last ten repetitions (usually one or two additional pounds). 77 General Exercise Guidelines: Of course, if there is still fatigue at the present level of weight, the client should stay at that level a little longer. At the beginning of each new week, increase the weight again if it s appropriate

40 TIEP: Subscapularis Stretch Watch the video at the end of the Webinar 79 TIEP: Subscapularis Exercise Watch the video at the end of the Webinar 80 40

41 Questions Facebook.com/DrBenBenjamin 81 Webinars Available On Demand Dr. Ben Benjamin Unraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh Pain Tom Myers Anatomy Trains: Clinical Applications of Myofascial Meridians Beyond Good Posture: Fascial Release for Structural Balance And Many More Whitney Lowe Orthopedic Approaches to Upper Body Disorders Orthopedic Approaches to Lumbo-Pelvic Pain Carole Osborne Pregnancy Massage 101 Tracy Walton Massage in Cancer Care More about Cancer Care & Massage Cardiovascular Conditions & Massage All Webinars Available at 41

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