Incorporating OMM to Enhance Your Clinical Practice Osteopathic diagnosis and approach to the upper extremity Sheldon C. Yao, D.O. Acting Department Chair March 1, 2013
Clinical significance Upper extremity problems are common due to the need for mobility there is decreased stability and increased risk of injury. MSK pain can be treated with OMT. Nerve impingements can also be potentially relieved with treatment. OMT has been shown to reduce pain, improve functionality, and decrease need for pain medications.
Evaluation - Feel 1. Bony landmarks - Sternum - Clavicle - S-C and A-C joints - Scapula - medial and inferior borders, spine, acromiom, coracoid process. - Humerus greater and lesser tubercles, bicipital grooves - Thoracic cage 2. Muscles -check for tone, atrophy, tenderness. 3. Tendons - Long head of biceps - Supraspinatus-at tip of acromiom.
Evaluation - Move Range of Motion Testing Flexion -180 degrees Extension -45 degrees Abduction -180 degrees Adduction - 45 degrees Internal Rotation - 55 degrees External Rotation - 45 degrees
Somatic Dysfunctions associated with shoulder pain Commonly affects clavicular articulations. May significantly restrict shoulder girdle motions. Check for dysfunctions above and below the affected joint. Treatment - must assure free motion at the scapulothoracic area and at the accessory joints.
Adhesive Capsulitis (Frozen Shoulder) Caused by Disuse / Immobilization Inflammatory process Seen in tense people with low pain threshold Prevention is most important. Increased risk with diabetic patients
Osteopathic considerations in Application of MET is useful in helping to restore muscles to proper length and remove restrictions of motion. Spencer s technique (an articulatory technique) is designed to increase ROM of the shoulder. Treatment of gleno-humeral dysfunctions, rib, clavicle, and thoracic dysfunctions will also improve ROM. Adhesive Capsulitis
Scapulothoracic Joint Scapulothoracic Between the anterior surface of the scapula and the ribs, with muscle and fascia between the bony surfaces.
Functional Mechanisms Scapulohumeral rhythm-during abduction, the scapula rotates upwards as the humerus elevates. For each 15 degrees of motion, the humerus accounts for 10 degrees while the scapula accounts for 5 degrees. This avoids impingement of the humeral head w/ the acromium, and supports the humerus in glenoid fossa against the effects of gravity.
Biceps Tendonitis Inflammation or degenerative changes of the tendon of the long head of the biceps Usually due to overuse or repetitive trauma Sign: + Yergason s test Medical Management: Rest, ice, lidocaine, steroid Osteopathic Management: Free up restrictions in the glenohumeral area Myofascial release Counterstrain technique for the bicep tendons
Anterior Shoulder CS Points
Posterior Shoulder TP
Extension Flexion Circumduction Spencer s Technique Circumduction with traction Abduction (adduction) Internal rotation Traction
Palpation/Motion of Radial Head Thumb is on anterior-lateral portion Index finger on postero-lateral portion a) supination/pronation motion b) Translatory anterior-posterior motion
Radial Head Diagnosis Diagnosis: Anterior Radial Head 1) Palpate radial head 2) Move through pronation 3) and supination 4) Anterior/posterior glide Glides more easily in anterior direction Restriction in posterior glide Forearm supination freedom Pronation restriction May be adducted elbow
Radial Head Diagnosis Diagnosis: Posterior Radial Head 1) Palpate radial head 2) Move through pronation 3) and supination 4) Anterioro/posterior glide Glides more easily in posterior direction Restriction in anterior glide Forearm pronation freedom Supination restriction May be abducted elbow
Median Nerve C6-C8 Fine control of the pincer grip Extrinsic flexors of the hand Intrinsic thenar muscles
Carpal Spread