Posterior Shoulder Tightness: A Case Study

Dr. Jeff Roderick is an experienced chiropractor who is certified in the Active Release Technique and trained in the myofascial release modality. He also holds an official Certified Chiropractic Sports Physician designation. Over the course of his career, he has served as a chiropractic sports medicine physician at the Salt Lake City Olympics, the team physician for the Madison and South Fremont high schools, and a chiropractor with Madison Ridge Chiropractic. While working for Madison Ridge, Dr. Jeff Roderick earned special recognition for excellent service and dedication to the chiropractic profession from the Logan College of Chiropractic.

When a patient tries to work through the aches and pains of either rehab or activities of daily life, they can develop pinpoint pain in their muscle due to compensation patterns that may hinder their performance. These pinpoint pains are commonly referred to as either active or latent trigger points. Active trigger points are known as highly localized, hyperirritable, taut bands of skeletal muscle fibers that can be felt by the patient without any palpation; while latent trigger points are pain-free until stimulated with palpation (Morihisa,Eskew, McNamara, & Young, 2016). These trigger points have been seen to be the cause of up to 85% of patients with the chief complaint of muscular pain (Unverzagt, Berglund, & Thomas, 2015). It is because of this that recent research on a technique called dry needling, has recently taken the sports medicine field by storm.

The project began with the formulation of a PICO question in an area of interest to guide the literature search. The PICO (population, intervention, control, and outcomes) format was used as a strategy for framing a foreground evidenced-based question. Dissecting the question into its component parts and restructuring was an essential first step in the evidence-based practice project. After careful consideration of the clinical manifestations and practitioner professional experience, the PIO question emerged was, Does Kinesio taping decrease pain and improve engagement in functional tasks in patients with shoulder pathology? Fortunately, there was sufficient evidence within the literature to support the PIO question.

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,

When a patient tries to work through the aches and pains of either rehab or activities of daily life, they can develop pinpoint pain in their muscle due to compensation patterns that may hinder their performance. These pinpoint pains are commonly referred to as either active or latent trigger points. Active trigger points are known as highly localized, hyperirritable, taut bands of skeletal muscle fibers that can be felt by the patient without any palpation; while latent trigger points are pain-free until stimulated with palpation (Morihisa,Eskew, McNamara, & Young, 2016). These trigger points have been seen to be the cause of up to 85% of patients with the chief complaint of muscular pain (Unverzagt, Berglund, & Thomas, 2015). It is because of this that recent research on a technique called dry needling, has recently taken the sports medicine field by storm.

On examination of the cervical spine, there is tenderness and tight muscle band is noted on both the sides of the paravertebral muscles. There is pain with extension and palpation of right facets.

In this academic journal Melanie Brown reports the benefits and experiences of using alternative and conventional methods to treat muscular skeletal pain. In this study Brown explains the methods people use to indicate what is going wrong or what is causing them problems and the methods they use in order to treat said ailment. Brown explains the methods and treatments used to treat muscular skeletal treatment, but she also shows the methods she used to collect the information. Brown used questionnaires, interviews,

Dynamic scapular dyskinesis is detected by asking the patient to raise and/or abduct both arms repeatedly in a rhythmic motion, until fatigue of the scapular stabilizers results in failure to keep the scapula well positioned in relation to the thoracic wall. Active scapular retraction and elevation are checked. The next step is to look for muscle atrophy and remember active and passive range of motion should be examined and compared with the non-injured shoulder. It is easy to detect muscle atrophy of the infraspinatus viewing from the back of the patient, whereas the supraspinatus is covered by the trapezius. Atrophy of the shoulder muscles is a common finding in patients with rotator cuff tears.

The baseball star, David Wright, is having another setback in his game because the newly diagnosed right shoulder impingement that requires immediate care and treatment. According to Mets General Manager, Sandy Alderson, Mets third baseman will have to sit out the games for the following few weeks and concentrate on the complete recovery.

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

I have been fortunate enough to observe my coach perform various techniques to restore mobility and motion.  One such technique that I was able to survey was the rehabilitation of an anterior shoulder dislocation. During the acute phase of therapy, isometric exercises were used to strengthen the rotator cuff muscles. The next phase was to achieve full range of motion without pain and continue to strengthen the muscles. This was done through abduction and external rotation, wall climbs/slides, and pulley’s.

Muscle strength and neuromuscular control is compromised. This could develop into long-term muscle weakness and motor planning dysfunction. Transcutaneous electrical nerve stimulation (TENS) could be utilized to help control pain and improve muscle weakness related to arthrogenic muscle inhibition. Evidence shows that TENS is effective in improving maximal voluntary torque and electromyographic signals of muscles (Konishi, McNair, & Rice, 2017). Mr. Versace may benefit from TENS on quadriceps femoris muscle to minimize muscle strength deterioration

The prime movers in the left shoulder that move it back to its neutral position are the anterior deltoid and the bicep brachii. Concentric contractions followed by eccentric contractions of both of these muscles move the shoulder from extension and abduction to it neutral state by flexing and adducting the shoulder. The prime movers in the right shoulder are again the anterior and middle deltoid along with the supraspinatus that contract isometrically to keep the shoulder in horizontal abduction. When the right shoulder is let down after follow through, the prime movers are the triceps and the posterior deltoids which eccentrically contract to extend the shoulder to its neutral position. Therefore the muscles of the shoulder are exceedingly imperative to the action of shoot a

Also, the right upper extremity was kept in protection with arm adducted and internally rotates, possibly subconsciously. All left upper extremity range of motion was within normal limits, no pain, no decreased range, some tightness of pectoralis muscles observed and some scapula dyskinesis. Right upper extremity was found limited to an active range of motion (AROM) performed in standing for flexion and abduction, the pain was present with instability, compensation and scapula dyskinesis. Following this step, the patient was supine position to measure passive range of motion (PROM), also pain was a limiting factor with muscle guarding end feel. Following, manual length test (MLT) of biceps was limited with replication of pain, mainly for the long head than for the short head. Additionally, manual muscle test was performed in sitting with a result of 3+/5 with pain present, and fear physiognomy was observed during testing. Additionally, special tests were performed to confirm diagnosis of the labrum tear; positive Speed test performed in a sitting position and Compression rotation test performed in supine position. Both special tests present with outstanding sensitivity and specificity. Limitations with activities like reaching up cabinets and washing his back were functionally addressed. Additionally, recreation activities like weight