Unraveling the Mystery of Shoulder Pain: More Joint & Bursa Injuries Presented by Dr. Ben Benjamin Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. ben@benbenjamin.com 1
Thank You DrBen@BenBenjamin.com Webinar Goal The goal of this webinar is to explore the assessment and treatment of injury to the acromio-clavicular and sternoclavicular shoulder joints as well as the sub deltoid Bursa of the shoulder. Things to Think About 1. What are the major signs of bursitis in the shoulder? 2. How does a therapist differentiate problems with the bursa from the gleno-humeral joint? 3. Do you know how to find the acromioclavicular joint with your finger? 4. Do you know the differences between chronic and acute bursitis? 5. Are you clear about which shoulder injuries hands on therapy cannot help? 2
Anatomy Acromio-clavicular Joint Acromion AC Joint Clavicle Acromio-clavicular Joint & Ligament 3
Sterno-clavicular Joint Sterno-clavicular Joint Articular Disc Anterior Joint Capsule The Gleno-Humeral Joint 4
Coracohumeral Ligament Glenohumeral Ligaments SGHL: superior glenohumeral ligament MGHL: middle glenohumeral ligament IGHL: inferior glenohumeral ligament Subscapularis 5
Supraspinatus Infraspinatus & Teres Minor Teres Minor Tendon Teres Minor Muscle Glenohumeral Joint Capsule 6
Subacromial Bursa Assessment Passive Elevation AC Joint and Ligament Tests 7
Passive Lateral Rotation AC Joint and Ligament Tests Passive Medial Rotation AC Joint and Ligament Tests Passive Horizontal Adduction AC Joint and Ligament Tests 8
Passive Horizontal Adduction with Elevation AC Joint and Ligament Tests Palpation AC Ligament Palpation Clavicular Press Supine Sterno-clavicular Joint & Ligament Test 9
Sterno-clavicular Ligament Palpation Sterno-clavicular Ligament Palpation Acute Bursitis Primary Assessment Test Acute Bursitis Test Passive Scapulo-humeral Abduction Acute Bursitis Test Passive Scapulo-humeral Abduction Passive Lateral Rotation Limited by 70 Limited by 45 10
Primary Frozen Shoulder Test Passive Lateral Rotation Frozen Shoulder Tests Passive Lateral Rotation Passive Scapulo-humeral Abduction Limited by 80 Limited by 45 Passive Medial Rotation Limited by 10 Acute Bursitis Tests Passive Scapulo-humeral Abduction Passive Lateral Rotation Limited by 70 Limited by 45 11
Chronic Bursitis Chronic Bursitis Test Theory Acromio-Clavicular Joint/Ligament Sprain Passive Horizontal Adduction Passive Elevation Passive Lateral Rotation Passive Medial Rotation 12
The AC Joint/Ligament Creates a bump 13
C4 Dermatome Sternoclavicular Joint & Ligament Sprain Clavicular Press Supine Test Sternoclavicular Joint & Ligament Sprain 14
Acute Bursitis Passive scapulohumeral abduction Acute Bursitis Chronic Bursitis Painful arc 15
Chronic Bursitis Chronic Bursitis Treatment 16
Friction Treatment of AC Ligament Sprain Treatment for AC Joint Inflammation Treatment for AC Joint Separation 17
Rehabilitation Rehabilitation Treatment for Sterno-clavicular Ligament or Joint Sprain 18
Friction Treatment of the Anterior Sterno-clavicular Ligament Treatment of Bursitis Both Chronic and Acute Problem #1 A client came in recently and said he did a judo roll and came down on his right shoulder really hard. He couldn t move his arm for about 5 hours. He said it hurts to do anything strenuous and especially if he tries to scratch his left shoulder when it itches. 19
Passive elevation Passive medial rotation Passive lateral rotation Passive horizontal adduction Problem #2 A person comes in with acute shoulder pain which came on about 2 weeks ago. They can t use the arm without pain and have trouble sleeping at night because of the pain. If they try to lie on it the pain is excruciating. Here are the tests that were painful and limited. Let s see if you can figure this one out. Passive lateral rotation limited by 20 Passive medial rotation is painful Passive horizontal adduction is painful Passive scapulo-humeral abduction limited by 70 20
Passive Scapulo-humeral Abduction Most Limited Passive Lateral Rotation Most Limited Acute Bursitis Passive Scapulo-humeral Abduction Most Limited Frozen Shoulder Passive Lateral Rotation Most Limited Questions Facebook.com/BenjaminInstitute 21
Title of Webinar Title of Webinar Date of Webinar Question 1 Possible Answer Options Question 2 Possible Answer Options Webinars Available On Demand Dr. Ben Benjamin Unraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh Pain Headaches Tom Myers Anatomy Trains: Clinical Applications of Myofascial Meridians Beyond Good Posture: Fascial Release for Structural Balance And Many More Whitney Lowe Orthopedic Approaches to Upper Body Disorders Orthopedic Approaches to Lumbo-Pelvic Pain Carole Osborne Pregnancy Massage 101 Growing a Prenatal MT Practice Tracy Walton Massage in Cancer Care More about Cancer Care & Massage Cardiovascular Conditions & Massage Hospital-based Massage Therapy All Webinars Available at www.benbenjamin.com 22
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