Unit 3 -- Relieve the Burden of Shoulder Dysfunction. Upper Torso & Shoulder Unit Study Guide

Transcription

1 Unit 3 -- Relieve the Burden of Shoulder Dysfunction Upper Torso & Shoulder Unit Study Guide This unit identifies problems of the shoulder joint and thoracic regions. Module 1 Module 2 Module 3 Module 4 Rotator Cuff Muscles Suggested reading from Myofascial Pain and Dysfunction The Trigger Point Manual, Volume 1: Chapters 22, 23, 21 and 26 Pectoralis Major and Minor, Deltoids & Serratus Anterior Chapters 42, 43 and 28 Latissimus Dorsi, Teres Major, Rhomboids and Serratus Posterior Superior Chapters 24, 25, 27 and 47 Scalene, Diaphragm & Intercostals Chapters 48, 49 and 47 Upon completion of each module take the 10 question quiz while the information is still fresh in your mind. Quizzes are taken and checked online. You can take each quiz as often as you want until a passing score of 70% is reached. The textbooks mentioned above can be ordered through: Lippincott Williams & Wilkins, 351 West Camden Street, Baltimore, MD 21201, , Though not required, it is strongly recommended to obtain a copy of the books to enhance your experience while participating in this program. Material in this manual has been reproduced from Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 1 & 2 by Drs Travell and Simons. The material found in this program is meant to educate not to harm. *This course has been approved by the National Certification Board of Massage Therapy and Bodywork ( ) and the Florida Board of Massage (50-302). When you complete this unit and pass the quizzes, you will earn 4 online CE hours. Students registered for the hands-on workshop will earn 16 CE hours for a total of 20 classroom CE hours. Copyright 1999, 2009, 2018 Catherine L. Cohen, L.M.T.

2 2 Rotator Cuff Muscles Suggested reading from Myofascial Pain and Dysfunction; the Trigger Point Manual Volume 1: Chapters 22, 23, 21 and 26 The five criteria for identifying active or latent trigger points: 1. taut bands 2. Exquisite 3. Patient of their pain complaint 4. range of motion 5. Local response Identify the following: Shoulder girdle bones Glenohumeral joint Acromioclavicular joint Sternoclavicular joint Pseudo joint

3 3 Source: Simons & Travell, pp. 602, 568 (1999).

4 4 Describe the anatomy and actions of the infraspinatus: Color in what you believe to be the referred pain pattern of the infraspinatus. Draw X over the documented trigger point locations. How is the infraspinatus activated and perpetuated?

5 5 Infraspinatus Nickname: Source: Simons & Travell, p. 553 (1999).

6 6 What findings and tests confirm involvement of the infraspinatus? What are the correctives? Hand-to Shoulder Blade Test places infraspinatus on stretch. Normal range is fingertips of nondominate arm to spine of scapula when arm length is normal. Source: Simons & Travell, p. 557 (1999).

7 7 Pain-relieving and pain- inducing sleep positions when right infraspinatus trigger points are active. A, neutral position of relief, with the affected arm supported by a pillow. B, poor position with the arm strongly adducted at the shoulder. This position can place the infraspinatus on painful stretch. Source: Simons & Travell, p. 562 (1999).

8 8 Describe the anatomy and action of the teres minor: How is the teres minor muscle activated and perpetuated? What findings, testing and corrective actions are similar to the infraspinatus?

9 9 Teres minor Nickname: Source: Simons & Travell, p. 565 (1999).

10 10 Describe the anatomy and actions of the supraspinatus: Color in what you believe to be the referred pain pattern of the supraspinatus. Draw X over the documented trigger point locations. When patients present with a painful shoulder, what diagnoses could they have been given? If presenting with a rotator cuff tear, which technique would you avoid performing?

11 11 Supraspinatus Nickname: Source: Simons & Travell, p. 539 (1999).

12 12 How would you test for a rotator cuff tear? What findings and tests confirm trigger point involvement of the supraspinatus? What activates and perpetuates this muscle? What corrective actions would you recommend for lasting relief from supraspinatus pain?

13 13 Describe the anatomy and actions of the subscapularis: To fully abduct or flex the arm, the humerus must? Color in what you believe to be the referred pain pattern of the subscapularis. Draw X over the documented trigger point locations.

14 14 SUBSCAPULARIS Nickname: Source: Simons & Travell, p. 598 (1999).

15 15 A moderately active subscapularis shows the following: ROM Testing: Visual confirmation: Palpation findings: What activates and perpetuates the subscapularis? What are the correctives? Source: Simons & Travell, p.610 (1999).

16 16 Pectoralis Major and Minor, Deltoids & Serratus Anterior Suggested reading from Myofascial Pain and Dysfunction; the Trigger Point Manual Volume 1: Chapters 42, 43, 28 and 46 Describe the actions of the pectoralis major. All fibers together Upper fibers Lower fibers Color in what you believe to be the referred pain pattern of the pectoralis major. Draw X over the documented trigger point locations. Clavicular Sternal Costal & Abdominal

17 17 Pectoralis Major Nickname: Source: Simons & Travell, pp. 820, 822 (1999).

18 18 List how the pectoralis major is activated and perpetuated. 1. Rounded shoulder position 2. Immobilization 3. Gross trauma 4. Cold air 5. Heart disease- viscerosomatic effect 6. Overuse What are some findings and tests? What are the corrective actions for the pectoralis major?

19 19 Describe the anatomy and actions of the pectoralis minor Color in what you believe to be the referred pain pattern of the pectoralis minor. Draw X over the documented trigger point locations. What activates and perpetuates the pectoralis minor? What findings and tests confirm pectoralis minor involvement? 1. Rounded shoulder posture 2. Horizontal extension 3. Restricted scapular movement If nerves in the brachial plexus are entrapped due to pectoralis minor tension, what are the symptoms? Name a few correctives.

20 20 Pectoralis Minor Nickname: Source: Simons & Travell, p. 846 (1999).

21 21 Describe the anatomy and actions of the deltoid. All fibers together Anterior fibers Medial fibers Posterior fibers Color in what you believe to be the referred pain pattern of the deltoid. Draw X over the documented trigger point locations. Anterior Medial Posterior

22 22 Deltoids Nickname: Source: Simons & Travell, pp. 624, 626 (1999).

23 23 How is the deltoid muscle activated and perpetuated? 1. Direct 2. Repetitive 3. Prolonged What are some findings and tests? 1. Back-rub Test 2. Thumbs-up tests anterior fibers Thumbs-down tests posterior fibers What are the correctives? Source: Simons & Travell, p. 641 (1999).

24 24 Describe the anatomy and actions of the serratus anterior Color in what you believe to be the referred pain pattern of the serratus anterior. Draw X over the documented trigger point locations. What activates the serratus anterior? What finding and tests confirm involvement of this muscle? Name some correctives.

25 25 Serratus Anterior Nickname: Source: Simons & Travell, p. 888 (1999).

26 26 Pictures from: Simons & Travell, p. 811 (1999).

27 27 Ergonomics for Your Computer Workstation Follow these guidelines for setting up your computer and using it in neutral posture at work and at home. Even in the best posture, you should not use the computer for more than an hour at a time without taking a break to stand up and walk around Head level, facing straight ahead, eyes gazing slightly downward. Monitor centered in front of keyboard, top of screen at eye level. Shoulders relaxed, back and down. Elbows at your sides with forearms parallel to the floor Keyboard and mouse at your elbow level and close to each other. Backrest slightly tilted back, and lumbar curve supported. Seat is level or tilted slightly forward, with thighs parallel to floor. Knees slightly lower than hips. Lauriann Greene and Richard Goggins Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition (Coconut Creek, Florida: Body of Work Books, 2008).

28 28 Latissimus Dorsi, Teres Major, Rhomboids and Serratus Posterior Superior Suggested reading from Myofascial Pain and Dysfunction the Trigger Point Manual Volume 1: Chapters 24, 25, 27 and 47 Describe the actions of the latissimus dorsi muscle Color in what you believe to be the referred pain pattern of the latissimus dorsi. Draw X over the documented trigger point locations. How is the latissimus dorsi activated and perpetuated?

29 29 Source: Simons & Travell, p. 573 (1999).

30 30 What are some findings and tests? What are the correctives? Mouth Wrap-around Test screens for full abduction and lateral rotation of the arm. Normally a person can reach around to cover half of their lips with their fingertips. This picture shows a restriction. Source: Simons & Travell, p. 489 (1999).

31 31 Describe the actions of the teres major. Color in what you believe to be the referred pain pattern of the teres major. Draw X over the documented trigger point locations. The activation, findings and correctives for the teres major is similar to what muscle?

32 32 Source: Simons & Travell, p. 588 (1999) Cathy Cohen

33 33 Describe the actions of the rhomboids. Color in what you believe to be the referred pain pattern of the rhomboids. Draw X over the documented trigger point locations. During trigger point examination, the tenderness adjacent to the scapula often represents the development of. What activates and perpetuates the rhomboid muscles? What are some findings and tests? What are the correctives? Cathy Cohen

34 34 GOING BEYOND Trigger Points 34 Rhomboids Nickname: Source: Simons & Travell, p. 614 (1999) Cathy Cohen

35 GOIN G BEYOND Trigger Points 35 Describe the actions of the serratus posterior superior. Color in what you believe to be the referred pain pattern of the serratus posterior superior. Draw X over the documented trigger point locations. How is the serratus posterior superior activated and perpetuated? Name some findings. What are the correctives? Cathy Cohen

36 GOIN G BEYOND Trigger Points 36 Serratus Posterior Superior Nickname: \ Source: Simons & Travell, p. 901 (1999) Cathy Cohen

37 37 Scalene Muscles and Respiration Suggested reading from Myofascial Pain and Dysfunction the Trigger Point Manual Volume 1: Chapters 20 and 45 To breathe in is largely a/an process. To breathe out is largely a/an process. Name the three basic chest movements controlling respiration. (Chapter 45) Describe the anatomy and actions of the scalene muscles Cathy Cohen

38 GOING B YOND Trigger Points 38 Color in what you believe to be the referred pain pattern of the scalene muscles. Draw X over the documented trigger point locations. How are the scalene muscles activated and perpetuated? 1. Trauma 2. Repetitive action 3. Coughing or paradoxical breathing 4. Elevated shoulders Cathy Cohen

39 GOIN G BEYOND Trigger Points 39 A B C Source: Simons & Travell, p. 506 (1999) Cathy Cohen

40 GOIN G BEYOND Trigger Points 40 What four tests validate scalene involvement? 1. Lateral flexion ROM test 2. Scalene-cramp test 3. Scalene-relief test 4. Finger-flexion test Cathy Cohen

41 GOIN G BEYOND Trigger Points 41 A. The Wright abduction test shows how the client is not allowed to elevate the shoulder to relieve tension on the brachial plexus. The Wright maneuver detects nerve entrapment beneath a taut pectoralis minor or a clavicle compressing the neurovascular structures against the first rib as the scapula is adducted. Arterial entrapment is detected by lose of the radial pulse at the wrist. Conversely, the scalene- relief test (pictured above) allows the shoulder to elevate and relieve tension on the brachial plexus. Source: Simons & Travell, p. 850 (1999) Cathy Cohen

42 GOIN G BEYOND Trigger Points 42 When tautness in the scalene muscles cause neurovascular entrapment, patients will present with what distinguishing symptoms? What are the correctives (see the following pages for corrective actions)? Cathy Cohen

43 GOIN G BEYOND Trigger Points 43 Scalene Correctives Stretch neck muscles three times a day (see picture). Practice coordinated breathing patterns (see picture). Maintain a neutral position of your neck by holding the phone in your hand. Shine light directly on reading material to avoid turning head sideways. Avoid a forward head posture by practicing good posture. When turning over in bed, roll the head without lifting it off pillow. Sleep on one soft shredded Dacron or feather pillow. Avoid solid foam. Keep your head straight at night by tucking the corners of the pillow forward between the shoulders and the neck. Elevate head of bed by placing 3 inch telephone books or blocks under the legs at the head of the bed. Use elbow rests when seated or when driving long distances. Keep arms into sides when lifting. Avoid pulling, hauling or tugging. Apply moist heat to the front of the neck 5-15 minutes a day. Keep your neck warm by avoiding drafts from fans and cooling ducts Cathy Cohen

44 GOIN G BEYOND Trigger Points 44 INSTRUCTIONS: Source: Simons & Travell, p. 531 (1999). Lie on your back. Each position passively stretches one of the three major scalene muscles. The exercise should always be done on both sides. A. The hand on the side to be stretched is anchored under the buttock. B. To stretch the scalenus posterior, the face is turned toward the direction of the pull. C. The face looks forward to stretch the scalenus medius. D. The face is turned away from the direction of pull to stretch the scalenus anterior Cathy Cohen

45 GOIN G BEYOND Trigger Points 45 A, erroneous paradoxical breathing, B-D, normal coordinated respiration. B, first completely exhale. C, then inhale using the diaphragm only, protruding the abdomen and keeping the chest collapsed. D, bring the air into the chest last. Once mastery of synchronizing the chest and abdomen is achieved, close the mouth and breathe only through the nose. Source: Simons & Travell, p. 533 (1999). Source: Simons & Travell, p. 534 (1999). Learning normal coordinated diaphragmatic breathing seated. A, breathe in through the nose while leaning back slightly, allowing the abdomen to move out and forward. B, breathe out easily through the loosely pursed lips, while slowly leaning slightly forward, so that the pressure on lower abdomen helps to push the diaphragm up and the air out. Slowly lean back slightly to begin another cycle. When a regular, relaxed rhythm has been established, try breathing only through the nose Cathy Cohen

46 GOIN G BEYOND Trigger Points 46 Color in what you believe to be the referred pain pattern of the intercostal muscles. Draw X over the documented trigger point locations. What activates and perpetuates the intercostals? What are some findings and tests? Name the correctives Cathy Cohen

47 GOING B YOND Trigger Points 47 When would a trigger point in the diaphragm refer pain? How is the diaphragm activated and perpetuated? What finding confirms involvement? What is the most useful corrective? Cathy Cohen

48 GOING B YOND Trigger Points 48 Intercostals Cathy Cohen

49 GOIN G BEYOND Trigger Points 48 Questions? Comments? I d love to hear from you! Please me at CathyCohen@BeyondTriggerPoints.com Find out more about additional Going Beyond Trigger Points Seminars: Cathy Cohen