Download Lumbar Flexion Syndrome

Humeral Anterior
Glide Syndrome
과 목 명 : 임상물리치료진단실습
담당교수 : 유 병 규 교수님
제 출 일 : 2007. 5. 29
발표자:곽문고
Symptoms, Pain problems, associated Diagnosis
• Pain
– Anterior or anteriomedial aspect of the shoulder joint
– Along the proximal one third of the biceps brachii tendon
– Manual resistance to elbow flexion, shoulder abduction performed
with the elbow flexed/ glenohumeral joint laterally rotated
• Pain increase
– Glenohumeral medial rotation
– Shoulder hyperextension, horizontal abduction, flexion (esp.
80~180degree)
• Symptoms
– Like bicipital tendinopathy, early stages of impingement syndrome
(supraspinatus tendinopathy & bursitis)
• Anterior dislocation can occur if the anterior joint capsule
has been weakened
Movement Pattern Impairments
• Excessive anterior motion of the
humeral head into the anterior joint
capsule
– Glenohumeral abduction
– Initiation of glenohumeral flexion
– Return from the end range of flexion
(elevation)
– Glenohumeral joint rotation with the
shoulder in 90 degrees of abduction
Alignment Impairments
• More than one third of the humeral head is
anterior to the acromial process of the
scapula
• The humeral head is more anterior than the
distal humerus
• The humerus is forward of the acromion in
addition to the anterior tilt of the scapula
• On the posterior surface, there is a slight
indentation below the acromion
Relative Flexibility & Stiffness Impairments
• The anterior joint capsule is more
flexible than the posterior capsule and
the glenohumeral lateral rotators
Muscle Impairments
• Recruitment patterns
– The action of the pectoralis major muscle
as a medial rotator of the glenohumeral
joint is more dominant than the action of
the subscapuralis muscle
– The infraspinatus & teres minor muscles
are recruited more strongly than the
subscapularis muscle when acting as
depressors of the humerus
Muscle Impairments
• Muscle length & strength impairments
– The lengthened or weak subscapularis muscle
• the anterior glide of the humeral head
– Shortness of the scapulohumeral lateral rotators
• Stiffness of the posterior capsule
– Preventing posterior glide of the humeral head
– Shortness of the pectoralis major muscle
•
•
•
•
Medial rotation of the humerus
the anterior position of the humeral head
Abducted position of the scapula
Increased anterior glide of the humerus during
shoulder lateral rotation & horizontal abduction
A. Normal shoulder flexion
B. Shortness of posterior joint capsule, so shoulder flexion result in humeral head upwardly
Confirming Test
• Prevents the anterior glide of the
humeral head during shoulder rotation &
flexion
– Decreases the symptoms
Treatment(1)
• Correct the anterior position of the humeral
head at rest
• Prevent the anterior glide during motion
• Shorten and strengthen the subscapularis
• Stiffness or shortness of the humeral lateral
rotators must be corrected to enable the
humeral head to glide posteriorly
• Shortness of the pectoralis major muscle should
be stretched
Treatment(2)
• Exercise improves the passive range into
– Medial rotation (supine)
– Horizontal adduction (supine; standing against a wall)
– Flexion (standing facing a wall)
• Exercise to strengthen the subscapularis
– Medial rotation (Lying on a table or bed in the prone
position)
• Exercise to humeral head posterior glide
– Flexion (quadruped position, standing)
• Assist in reducing the stress on the anterior joint
capsule
– Taping (force to pull the humeral head posteriorly)
• Correcting scapular alignment
– Forward or depressed position
Case presentation
Client’s history
• 34-year-old woman
• Pain
–
–
–
–
Shoulder abduction (esp. against resistance)
Shoulder flexion at the end of the range
Has been present for 3weeks
At rest (X), awakened by pain at night (X)
• Ballroom dancing, upper extremity Wt.
training
Alignment analysis
• Slight thoracic kyphosis
– Rectus abdominis muscles is the primary cause
• Scapulae are abducted & slightly depressed
• Both scapulae are positioned more than 3 inches
from spine
• More than one third of the head of the Lt. humerus
extends beyond the acromion
• The proximal end of the humerus is anterior to its
distal end
• Humeral alignment of the Rt. Upper extremity is
normal
• Shortness of the pectoralis minor muscle
Movement analysis
• During shoulder flexion, the scapula remains
depressed & doesn’t adduct at the end range
of shoulder flexion
• During shoulder flexion with elbow flexed,
medial rotation of the humerus is observed;
with the elbow extends as the shoulder
flexion motion is completed (end range pain)
• Hand up a wall, creating a slight
posteroinferior force on the humerus while
maintaining lateral rotation (without symptoms)
• In standing position with elbow flexed, the
humeral head can be observed to glide
anteriorly when she performs lateral rotation
Muscle length & strength analysis
• Pectoralis minor muscle shortness
• Lt. lateral rotators are short
• During glenohumeral medial rotation, anterior
glide of the humeral head is observed
• Medial rotation of Rt. Humerus is 70 degrees
(Lt. side 50 degree)
• Shortness of the teres major of Lt. side
• MMT
– Lt. medial rotators (3+/5)
– Lt. lower trapezius muscle (4/5)
Pectoralis minor muscle stretch
Diagnosis
• Humeral anterior glide & scapular
abduction syndromes
Treatment
• Supine exercises
– Instruction: stretch the pectoralis minor muscle
– Stretch abdominal muscles
– Performs shoulder medial rotation
• Prone exercises
• Quadruped exercises
– Rock backward toward the heels
• Standing exercises
– Facing the wall
– Back to the wall
• Maintain lateral rotation as the shoulder flexes with elbow
flexed
– Stretch the rectus abdominis muscle
• Performs shoulder abduction pain present try to adduct Lt.
scapula before abducting from 90 degrees to full elevation
relieve pain
Prone exercises
Facing the wall
Outcome
• 2 weeks
– Achieve 70 degrees of Lt. arm medial rotation but has to apply
strong pressure to the proximal humerus to prevent anterior glide
of the head
– Doesn’t have pain with abduction or flexion as long as she
adducts her scapulae before reaching the end of the range of
shoulder flexion
• 4 weeks
– Shoulder rotation exercises are performed using 2-pound Wts.
– Lower trapezius exercise in prone
• Two more sessions
– Increase her Wts. to 3 and then 4-Pound in each hand
– Begin using 2-pound Wts. during the motion of elbow & shoulder
flexion to elbow extension
• 6 weeks
– Pain free with all motions
– No longer demonstrate anterior glide of the humeral head during
shoulder rotation movements
The End!
Thank you!