The musculoskeletal system is linked.
So pain in one place is often gonna
manifest itself as pain in another place.
and pain is often gonna coexist in multiple
areas of the musculoskeletal system
This is not unusual for a
person with a kyphotic back
to develop shoulder pain as it
rotates inward and flexes forward.
So we're gonna focus on the shoulder pain,
and what could be causing the shoulder pain
and try and localize it to the areas
that are going to be affected.
So a common cause of shoulder pain
is gonna be clavicular dysfunction.
So if the clavicle isn't working well,
and I'm gonna check the clavicle,
at the sternoclavicular junction
and seeing if there's motion
If there is adduction or abduction, or
external rotation or internal rotation,
or extension, or flexion - those
things can cause pain in the shoulder
Let's start with what I would do if this
patient had ADduction of the clavicle.
So I would try and localize
the area - find the area,
find the tender point if it's easy, or think
about doing a muscle energy technique.
And if I'm gonna be doing a tender point because
I have an area that's soft, tender about 2 cm,
Does that feel tender?
For purposes of the video, we're
gonna say this is tender though.
and then I would try and find an area of
ease where I feel some easing up the muscle,
do some internal rotation
and find an area
Once I find an area of ease, and
assume that the pain is gone
and you get 70% benefit with
you can hold it for 90 seconds,
allow it to ease up,
So for muscle energy procedure, you gotta
find the sternoclavicular junction,
and I'm gonna have him use his muscles
to free it up and to relieve some of the pain.
So what I would do is I would bring
him closer to the end of the table,
A little more, good.
Get the sternoclavicular junction,
take the arm, put it in a little bit of
extension, a little internal rotation
and then have him lift his arm up.
Let me have you put pressure
So 3-5 seconds and then
relax, 3-5 seconds push again
One, two, three, four, five - relax.
and get more
And this will help free up
motion and the clavicle
Let me have them move back a little bit.
If he has an extension
lesion, I'd want to
have him hold my shoulder, I'm
gonna check the clavicle and
pull the scapula as well.
There are a couple ways of doing this.
I can have him push down on my shoulder with his
arm therefore pushing his scapula backwards
or I can have him push his
shoulder down towards the table
and which one is more comfortable?
(left to shoulder)
Left to shoulder down?
So let me have you push the shoulder down towards
the table, and I'm gonna monitor the clavicle.
Push - one, two, three - relax.
And I'm gonna push the proximal portion
of the scapula deeper posterior
In that way the distal
portion will go anterior.
Push down the shoulder again.
one, two and three - and relax.
and I'll lift it up.
and one more time, push
down with the shoulder
One, two, three - and relax.
and that's how I would treat a muscle
energy procedure for the clavicle.
Another common cause of shoulder
pain is going to be rib dysfunction.
and when you look at the rib tender points, the
tender points are both anterior and posterior.
From an anterior perspective,
tender point number one
For rib number one, it's gonna be under
the clavicle where it meets the sternum,
So just underneath is gonna be tender
point number one for rib number one.
That's a difficult way and a tender way to get to the
rib, but that's how you're gonna find the tender point.
Rib number two is gonna be
in the midclavicular line
right below this second intercostal space.
(rib) 3, 4, 5 are going to be medial just
to the side of the sternum - so three, four and five
There are also going to be anterior axillary
line points for ribs 3, 4 and 5 on the rib
Let me have you sit up
Posteriorly, you're going
to have tender points
at the angle of the rib from
T1 all the way down to T12
So let me have you lay down again.
In treating the tender points,
basically you find the tender point,
and then have them look at it.
I'll flex the neck, sidebend and rotate
towards it so he sees the tender point
In the ribs, this is different
than the other tender points.
We hold this for 120 seconds
not the standard 90 seconds
These are the ribs, they got 120
seconds of looking at the problem,
relaxing and then letting
them return to midline
Again the important part with shoulder pain, with
chest pain is always starting with the diagnosis,
knowing what you're treating, treating it and
assessing the effectiveness of your treatment.