Testing for shoulder dysfunction.
There are 4 joints that I test as part of overall assessment of the shoulder. These are:
1. The Sternoclavicular (SC) joint.
2. The Acromioclavicular (AC) joint.
3. The Glenohumeral joint (shoulder joint)
4. The Scapulocostal joint.
The last of these is not a true joint, but is treated like one because of it's importance in shoulder abduction. Dysfunction in any of the above joints will cause difficulties in one or more movement actions at the shoulder.
The Sternoclavicular joint is found at the medial end of the clavicle. During abduction of the shoulder this joint need to drop down and during horizontal adduction it should move back (posteriorly). Testing the joint is simple enough.
Stand facing the client and position your thumbs on top of the medial end of the clavicle. Ask the client to slowly shrug their shoulders and you should feel both the joints drop down. If one or both do not drop they need to be treated.
Next, with thumbs in the same position, ask the client to position the arms straight out in front of them and reach forward. When they do this the joints should move back. Again if this does not happen some treatment will be required.
One simple way to treat the SC joint if it's not dropping down is to take the clients shoulder into extension and place the thumb once again on the affected joint. Ask the client to gently try and move their arm back to their side while you resist. Hold for a few seconds while applying some pressure to the joint with the thumb. Take the arm further back into extension where possible and repeat 2-3 times. After retesting the joint should be dropping as normal. Note this method can also restore sc joint movement if it was failing to drop back as well.
A second method is to apply pressure to the joints as the client reaches forward in the same way they did on the test. As they reach you apply light pressure to the joint and then relax after a few seconds. Repeat 4-5 times and retest.
The AC joint sits at the lateral end of the clavicle where the clavicle meets the acromium. It can be felt as either a groove or a pronounced bump on top of the shoulder. The acromium moves on the clavicle during some shoulder movements. The acomium should move up in relation to the clavicle when the shoulder is elevated but can become restricted.
Various checks can be made on the AC joint while testing different movements of the shoulder. During these movements you are checking for restriction by monitoring the joint whilst performing MET type work on any restircted movements. I place two fingers on the joint during these tests and if it feels restricted I apply a little light pressure and movement simultaneously with the specific MET I'm doing. A simple example would be testing abduction of the shoulder.
Positioned behind and slightly to the side of the client, place two fingers on the AC joint and ask the client to abduct the arm as far as possible. You should feel movement at the joint as the arm moves up, especially past 90 degrees. If abduction is restricted, you can sit the client down and move to the side. Have the client place their arm on your shoulder starting at a low position so their arm is lower than 90 degrees. Move their arm to the restrictive barrier and then have them push gently down on your shoulder for a few seconds. When they relax you can stand taller and move the arm to the new barrier. All the time monitoring the AC joint for restriction and applying a little movement if needed.
The Glenohumeral joint is what people refer to as the shoulder joint. There are many movements here and you can test them all (internal and external rotation, horizontal adduction etc). You can perform MET's (Muscle Energy Techniques) on any of these movements that are found to be restricted, along with specific soft tissue work if needed. Dramatic changes can often be seen with all of this mobilisation work. Additional shoulder techniques to create sub-acromial space, work on the bicep to prevent the head of the humerus being pulled too tightly into the cavity, pec major, minor, and subscapularis release, plus toning the other rotator cuff muscles if necessary, will all improve the health of the shoulder joint. I'll be showing many of these techniques in a later blog.
Lastly the Scapulocostal joint needs to be tested during shoulder abduction. For normal function, the scapula should not begin upward rotation until the arm reaches 80-90 degrees of abduction. This is easy to test by placing the fingers on the lateral border of the scapula, and then asking the client to abduct the arm and checking when the scapula moves. In clients with frozen shoulder or other dysfunctions, the scapula will start to rotate much earlier and shrugging and some leaning can also be seen because the shoulder joint is unable to do it's job during abduction.