The shoulder joint is suspect to many different
potential causes for pain and injury.
Again, due to its mobility, it could be injured
in many different ways.
Osteopathic diagnosis and treatment could
help you with identifying the cause
of the issue and also with helping your patients to recover from the injury.
Shoulder dislocation occurs when the humeral head is displaced from the glenoid fossa.
Most commonly, dislocation is anterior and inferior
because of the weakness of the labrum
and how the muscles are attached. So, the
shoulder tends not to dislocate posteriorly.
After dislocation, patients usually
are holding their arm
in a specific position of abduction
and external rotation.
Usually there's a drop off of the shoulder
when you compare in observation.
A special test that you could perform to confirm it is called the apprehension test.
If someone presents with
a shoulder dislocation,
immediate reduction and
immobilization is required.
The reduction is required to put
the shoulder back into place
so that you don't compromise neurovascular
flow to the rest of the arm.
You want to provide
Then at times, you may need
surgical repair for certain cases.
Osteopathic manipulation could
help accelerate recovery.
After reduction or surgery, treatment of
the shoulder with gentle technique
could help with decreasing some of
the pain and edema in the area.
Then you want to strengthen and
increase his range of motion
after surgery to help prevent
frozen shoulder from occurring.
The apprehension test could
be used to evaluate for
any sort of instability of the
shoulder to dislocate.
If the patient has a dislocated shoulder
and it's extremely obvious
this would not be something
that you would do.
So, if someone has a suspected
where they said that their
shoulder really hurts
and it felt like it kind of
popped out and popped in,
you could kind of test for
the integrity of the joint
by trying to place them into a position
and seeing if they elicit a response.
So, how is it
Your physician will abduct and externally
rotate the arm to about 90 degrees.
Then you're going to apply an anterior
pressure on the humerus.
So, as you apply that anterior
pressure on the humerus,
if the shoulder is unstable, then the
patient is going to have pain
and appear apprehensive,
thus the name of the test.
So a positive test is if the patient
has pain or apprehension
due to the force on the shoulder
for the patient would feel like
he is potentially dislocating
Another potential issue with shoulder
pain is shoulder separations.
This is usually due to some sort of traumatic
force to the shoulder joint itself,
some sort of blow or pull
that separates the clavicle
at the acromioclavicular
Sometimes you can have a shoulder
separation at the sternoclavicular ligament
but a lot of times
that is more rare.
Usually, you could have a partial tear,
or sometimes it could be a sprain,
or in the case of this image there's a complete
tear because of the distance.
You can usually identify
this via X-ray.
Sometimes there could be some
sort of fall on the point.
Sometimes you might see
this with sports injuries.
So, it's important to rule this out with
patients that have shoulder pain.
Sometimes you might see a
little bit more of a step off
in the region when
examining the AC joint.
When you find this, you want to make
sure that you support the shoulder.
Usually, the shoulder will be
immobilized if it's really severe.
A complete separation surgery
may be required at times.
Osteopathic manipulative medicine
can help with helping to decrease
some of the swelling and pain in the area,
decreasing some of the muscle spasms
that may occur secondary
to the shoulder injury,
and also using some gentle techniques
to try to mobilize the joint
after it's healed to help
restore motion in the area.
Rotator cuff tears
Patients usually will complain about
a soreness in the shoulder,
pain with trying to
abduct the shoulder.
The most common tendon that's injured among
the rotator cuff is the supraspinatus.
It is really a lot more at risk based
on the way that it traverses
from the scapula to the glenoid and past the
glenoid and onto attach on the humerus.
The symptoms, usually patients are
typically greater than 40 years old.
There are certain special tests that
you could perform to try to see
if the tendon
is still intact.
The drop arm test and the empty can test
both test for the stability
and the intactness of that
Usually, you could manage any
sort of small tear inflammation
with some anti-inflammatories,
rest, and ice.
However, if there is a full tear or severe injury,
there might be a need for surgery.
If it is infraspinatus or subscapularis tear
then surgery is also required.
Osteopathic management include
gentle, indirect, passive techniques
trying to free any sort of restrictions
in the glenohumeral area,
try to treat any sort of
So if someone has
a rotator cuff tear,
they're not going to want to move their
arm especially with abduction.
So, they’ll try to compensate and they'll
start shrugging their shoulders
to reach up higher,
to grab things.
So, there might be other muscles
around the scapula itself,
the thoracic cervical region, the back,
that becomes more spasmed.
We could try to treat specific points in
the shoulder that might be tender
with counterstrain technique,
facilitate positional release.
Myofascial release could help soften up some
of the spasmed muscles in the area.
So, the drop arm test is a test to
test for rotator cuff tears.
What you're going to ask is for the
patient to slowly raise their arms
up over their heads and touch the
back of their hands together
and slowly try to bring their
arms down to their sides.
If someone has a true
rotator cuff tear,
they're probably not going to be able to
even bring their arm up over their head.
But if they're bringing their arms down
and then they can't smoothly
and in a controlled fashion bring
their arms down to their side,
then that might indicate that the supraspinatus
muscle has a tear in it
because the supraspinatus muscle
really performs abduction.
So, as you slowly
bring the arm down,
The supraspinatus has to be
intact in order to help
support the abduction
of the arm.
The empty can test is another test
to test for rotator cuff injury and tears.
Here, you're going to have the patient
turn their thumb down
like they're emptying a can and then
abduct their arm out to the side.
With their arms to the side and
their shoulder internally rotated,
you're going to gently push
down on their arms
to see if they're able to
resist your force.
So, when you abduct and internally
rotate your shoulder,
what you're doing is you're compressing
on that suprahumeral space
where the supraspinatus
tendon runs through.
So, if a patient has a tear there or
severe inflammation or injury,
they're not going to be able to resist your
force pushing their shoulder down.
So, a positive test is if they cannot hold
their arm up against your resistance.