Project Senario-Client#2 Client is complaining about pain in the shoulder, especially when arm is raised overhead. He is a Crossfit enthusiast who works out 4-5 times a week. He notices that when he goes to lift any weights or does movement above his head that his shoulder pain worsens. He is at this point unable to move his arm above 45 degrees.
Since the clients complaint is due to an increase of pain when extending his arm above 45 degrees the origin of the problem is in the shoulder. The following muscles are a few of the ones responsible for extension of the shoulder.
The following muscles and their actions aid extension of the arm. One of these muscles tightening may have cause this clients lack of flexibility.
Deltoid- Insertion- Deltoid Tuberosity , Origin- Lateral one-third of clavicle , acromion and spine of scapula. Actions- (anterior fibers) Abducts/, flex, medially rotates the shoulder; (posterior fibers)horizontally abducts,extend, laterally rotates the shoulder
Latissimus Dorsi- Insertion- intertubercular groove of the humerus.Origin-Inferior angle of the scapula , spinous processes of the last six thoracic vertebrae , last three or four ribs , thoracolumbar aponeurosis and posterior iliac crest. Actions- Extend the shoulder ( glenohumeral joint) , Adduct the shoulder, medially rotate the shoulder.
Teres Major- Insertion- Crest of the lesser tubercle of the humerus.Origin-Inferior angle and lower one-third of lateral border of the scapula. Actions- Extend the Shoulder (g/h joint),Adduct the shoulder, Medially rotate the shoulder.
Teres Minor- Insertions- Greater tubercle of the humerus. Origin- Upper two-thirds of the lateral border of the scapula. Actions-Laterally rotate the shoulder, Adducts shoulder, Stabilize the head of humerus in glenoid cavity.
Supraspinatus- Insertions- Greater tubercle of the humerus. Origin- Supraspinatus fossa of the scapula. Actions-Abduct the shoulder, Stabilize the head of the humerus in glenoid cavity.
Infraspinatus- Insertions- Greater tubercle of the humerus. Origins- Infraspinatus fossa of the scapula.Actions-Laterally rotates the shoulder (G/H joint) , Adducts the shoulder, Stabilizes the head of the humerus in the glenoid cavity.
Subscapularis-Insertions-Lesser tubercle of the humerus. Origin- Subscapular fossa of the scapula. Actions- Medially rotates the shoulder (G/H joint) , Adducts the shoulder, Stabilizes the head of the humerus in the glenoid cavity.
Pectoralis major ( lower fibers)-
Pectoralis major ( lower fibers)-Insertions- Crest of the greater tubercle of the humerus. Origin- Medial half of clavicle, sternum and cartilage of the first through six ribs.Actions- Only job is to extend the shoulder.
Triceps brachii (long head)
Triceps brachii (long head)-Insertions- Olecranon process of the ulna. Origin- (Long head) infraglenoid tubercle of the scapula. Actions- Extend the shoulder ( glenohumeral joint) Adduct the shoulder (G/H joint).
Mt175 kinesiology upper section D
Kinesiology Upper Project
Miller-Motte technical college
When this client came to me about a pain in his shoulder. To solve this client's problem I used a 12 step protocol. The steps are as the following: client history, active range of motion, passive range of motion, resisted range of motion, area prep, myofascial release/compression, gliding strokes/trigger points, multidirectional friction, pain free movement, eccentric scar tissue alignment, stretching,and strengthening.
During the beginning stages of client assess I tested his range of motion before the massage and discovered the tightness in supraspinatus in his left arm. He said the pain also worsened when I had him resist upward against my light pressure push downward.
Once I palpated supraspinatus I discovered an active satellite trigger point in the middle of the belly of the muscle fibers. I hypothesized that the satellite has come from the client overworking his muscles doing crossfit exercises several times a week.In order to treat my client's condition I applied trigger point therapy during the sesion.The trigger point did not dissipate completely however the main one did decrease in size. I sent the client home with homework to do stretches(Pendulum Swings
Stand and lean over with arm hanging. Begin swinging the arm in small circles and gradually enlarge the size of the circles. Repeat 10 times.) and heat compression and to reschedule an appointment with me again in the next few weeks to hopefully to cure the client of the trigger point completely.
Credits: American Physical Therapy Association. Guide to physical therapist practice. second edition. american physical therapy association. Phys Ther. 2001;81(1):9-746.
2. Chang W. Shoulder impingement syndrome. Physical Medicine and Rehabilitation Clinics of North America. 15 (2004) 493–510.
3. DeBerardino T. Supraspinatus Tendinitis Treatment & Management. Medscape Reference. http://www.emedicine.medscape.com/article/93095-treatment
4. McLaughlin E. Supraspinatus Tendinitis: Rotator Cuff Tendinitis. Medicine on Line. http://www.medicineonline.com/articles/s/2/supraspinatus-tendinitis/rotator-cuff-tendinitis.html
5. Razavi M, Jansen G. Effects of Acupuncture and Placebo TENS in Addition to Exercise in Treatment of Rotator Cuff Tendinitis. Clinical Rehabilitation. 2004; 18:872-877.
6. Rees J, Maffulli N, Cook J. Management of Tendinopathy. The American Journal of Sports Medicine. 2009; 37:1855-1866.
7. Senbursa G, Baltaci G, Atay A. The effectiveness of manual therapy in supraspinatus tendinopathy. ACTA Orthopaedica et Traumatologica Turcica. 2011;45(3):162-167.
8. Starr M, Kang H. Recognition and management of common forms tendinitis and bursitis. The Canadian Journal of CME. 2001; 155-163.
Morphopedics. (n.d.). Retrieved February 06, 2017, from http://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis
Google images: Google Images. (n.d.). Retrieved February 06, 2017, from https://images.google.com/
Biel, A., & Dorn, R. (2010). Trail guide to the body: a hands-on guide to locating muscles, bones, and more. Boulder, CO: Books of Dicovery.