Anatomy related questions(humerus cannot medially rotate)

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Permalink Reply by Gordon J. Wallis on December 24, 2012 at 1:38am

Yea I was depressed,  but ya know. My smart phone being stolen is nothing... Those parents that lost their chideren from that shooting.   I cant imagine.  People suffer for real... I only complain. My ranting in here is nothing.

Gary W Addis said:

Gordon will be having a snowy Christmas.  Just heard the weather report for the Gulf Coast...supposed to be 71 on Christmas Day, but storming (hard rain, lightning, no snow).  I'm sick with the flu, Gordon's new smartphone was stolen.

So, like probably millions of others, we're tempted to say bah humbug this Christmas.  But, things could be worse.  And tomorrow is another day.

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Permalink Reply by Jody C. Hutchinson on December 24, 2012 at 8:55am

Gary,

The supraspinatus muscle is loaded first with any arm abduction.  It takes the force until the deltoid fires. The supraspinatus is the most commonly torn muscle of the rotator cuff and has very little blood supply at the distal end. Look up "full thickness" tear of the supraspinatus. Anyone who picks up an object at their feet and lifts it-like luggage, a bag, etc. is going to load that muscle.

I don't want to argue here, but in 25 years I have never seen a "frozen shoulder" resolve in less than several months.

Maybe it's the water in California.

Cheers,

jh

Gary W Addis said:

I agree with Gordon.  She is a female, and not an athlete who regularly overtaxes her body, correct?  So, how did she get the "tearing" of the supraspinatus tendon?  Tendons are incredibly tough; they don't tear easily.  Do the assessment tests. 

If YOU can lift the RELAXED arm without causing the client pain, then the problems is definitely muscular, not within the joint. 

I like Whitney Lowe's body of work, but before you go into a lot of complicated, often painful Rolfing-like treatments, I suggest you search her body from top to toes for trigger points--trigger points on the contralateral side may be causing the problem, btw.  The body is pretty damn good at establishing its own optimum posture.  Trust it.  Take out the trigger points, one or two sessions and one follow-up session. 

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Permalink Reply by Gary W Addis, LMT on December 24, 2012 at 12:34pm

I assure you, I know the actions of the supreaspinatus.  Having been a competitive bodybuilder/powerlifter for four decades, I am also quite aware of the strength of tendons.  I've seen tendons ripped from bone in the gym, but during a competition, I witnessed an ulnar break because the powerlifter 's mind control defeated the golgi tendon reflex, and the bone itself shattered.

Tendons do not easily tear, my friend...it takes a great amount of force and/or degenerative disease of connective tissue, such as arthritis.  A woman simply stretching above her head, or swinging heavy luggage into an overhead rack ain't gonna tear that supraspinatus tendon-- the body prevents the generation of that kind of force by shutting down.  (Otherwise, you'd be capable of lifting the front end of a pickup--the muscle itself is capable of generating immense power, but strength is diminished significantly by activation of the golgi tendon organ. 

That the client has difficulty abducting the arm does not automatically make it frozen shoulder.  I asked Brendan a cogent question: is it painful when passively lifted? If it is painful when moved while fully relaxed, yeah, there is a problem within the joint.  If it is only painful when the client fires the muscle, then it definitely is NOT tendon / ligament damage.

Regarding treatment, IF-- a very big IF-- it is a tendon tear, yes, recovery will take awhile--months, probably not.  However, the majority of cases of frozen shoulder are misdiagnosed.  Usually, it is nothing more serious than trigger points.  Therefore, Brendan, I advise you to consult a good trigger point chart.  Even if there is ligament damage, there will still be protective trigger points in one or more of the agonists, and maybe in antagonists as well. 

Remember, Brendan: it's all about protecting the joint; to save a child or lift a world record clean and jerk, you might be able of overcoming protective mechanisms and damage the joint, but the body really doesn't give a $%$ whether you can swing that overstuffed bag up to the overhead bin--to prevent damage to the joint, brother, golgi tendon organ will signal muscle spindles to severely limit the force generated.

Gordon is right, of course.  no need to make it complicated.  Search for the sore spots and take them out.  One, maybe two sessions to find them all.  Advise the client after treatment to give the injury time to heal.  Make no mistake, a trigger point is an injury inside the muscle, and needs a chance to heal before stretching or significant "testing to see if it still hurts."

Jody C. Hutchinson said:

Gary,

The supraspinatus muscle is loaded first with any arm abduction.  It takes the force until the deltoid fires. The supraspinatus is the most commonly torn muscle of the rotator cuff and has very little blood supply at the distal end. Look up "full thickness" tear of the supraspinatus. Anyone who picks up an object at their feet and lifts it-like luggage, a bag, etc. is going to load that muscle.

I don't want to argue here, but in 25 years I have never seen a "frozen shoulder" resolve in less than several months.

Maybe it's the water in California.

Cheers,

jh

Gary W Addis said:

I agree with Gordon.  She is a female, and not an athlete who regularly overtaxes her body, correct?  So, how did she get the "tearing" of the supraspinatus tendon?  Tendons are incredibly tough; they don't tear easily.  Do the assessment tests. 

If YOU can lift the RELAXED arm without causing the client pain, then the problems is definitely muscular, not within the joint. 

I like Whitney Lowe's body of work, but before you go into a lot of complicated, often painful Rolfing-like treatments, I suggest you search her body from top to toes for trigger points--trigger points on the contralateral side may be causing the problem, btw.  The body is pretty damn good at establishing its own optimum posture.  Trust it.  Take out the trigger points, one or two sessions and one follow-up session. 

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Permalink Reply by Brendan Zachar on December 24, 2012 at 2:54pm

Unfortunately, I wish 2-3 sessions with trigger points could take care of this but it's a bit more complicated. I'm not saying it's impossible but I guess she's the exception. She had about 3 months of PT with no improvement. I've seen her about 9 times, she has shown improvement but she's reached a sticking point. The problem is really an occupational thing TBH, but I'm doing my best to offer her relief. I usually do about 30-40 mins of deep tissue fascial work and then follow up with some acupuncture.

Her scapula and subscap seem to be "Glued" together but slowly seems to be unwinding a bit. I truly believe it's a slow process, as this didn't happen overnight and is not going to resolve over night. 

Thanks for the all the insight thus far.

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Permalink Reply by Gary W Addis, LMT on December 24, 2012 at 5:21pm

The question is still relevant,  "Is it painful when you lift the arm with no contraction of her muscles?"  If it is not, it is not frozen shoulder... it is not tendon.  If it is only painful when she moves the arm, it absolutely is soft tissue etiology.   And, overwhelmingly, soft tissue issues are the result of trigger points. 

(Occupational thing, as in Workmen's Comp?)

A rhetorical question:  if you pull on either end of a knot, what happens? it gets tighter.  If physical therapy hasn't fixed it in 3 months they are unlikely to in a year through strengthening and stretching exercises.  And neither are you with lengthening and shortening strokes. 

Brendan, I don't know you, not judging.  But how are you with trigger points?  A survey conducted a few months ago by one of our organizations reported that only 40% of massage therapists claim any expertise working with trigger points-- and it is a safe bet that the actual percentage who can find and release a trigger point will be half that.  No mark against those who can't, just means that their training concentrated on the massage rather than the therapeutic.  It is a certainty that as we speak everyone has at least one tender point (i.e., trigger point) somewhere on their body.  Refer out to one who can find them and fix them if you need to.  Now, please don't take offense: I don't doubt your skills.  You've done all the right things, all by the book.  But if that isn't working, it's time to close that book and try something new: trigger point therapy.

Myofascial trigger points do happen overnight, but worsen over time as more and more protective TPs are formed; they can be taken out literally in seconds, and with surprisingly light pressure using some of the new techniques.

Consider also: if this is occupational illness, covered by workmen's comp, no one wants it to be healed quickly.

Merry Christmas, Brendan.

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Permalink Reply by Gordon J. Wallis on December 24, 2012 at 6:37pm

If there is no underlying osteopathology, bones in the way.. Its easily fixed..  The laat lady had four and a half moths of PT.. They told her she may need surgery.  She was freaked out.. I had her in pain free full range of motion in one session.  Its a joke to me.   If there is no seveir osteopathology,  Then its muscular. Soft tissue work.  If there are any tender areas or sore spots in any of the muscles of the shoulder girdle.. If you make them go away. So does the Frozen Shoulder. Thats my experience.   I like to get people with frozen shoulder.  I get excitted.. Because I know I can help them. And if they have been seeing PTs, Im even more excited.. lol

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Permalink Reply by Gordon J. Wallis on December 24, 2012 at 11:55pm

To me Frozen shoulder, if there is no underlying osteopathology, the same thing as Carpal tunnel or that Plantar fasciitis. Only in a different place.  People do surgery for those to.. Same thing to me... Only in a different part of the body. If the PTs have worked on them for weeks.  That eliiminates any severe tear, because that would be surgery right away, and would not even go to physical therapy...not arguing with anyone.. Ive just helped so many with frozen shoulder.. I feel very confident if they have gone though physical therapy.. because that means no osteopathology or severe tendon tears...And once those are ruled out.... Its soft tissue work all the way.  

Gordon J. Wallis said:

If there is no underlying osteopathology, bones in the way.. Its easily fixed..  The laat lady had four and a half moths of PT.. They told her she may need surgery.  She was freaked out.. I had her in pain free full range of motion in one session.  Its a joke to me.   If there is no seveir osteopathology,  Then its muscular. Soft tissue work.  If there are any tender areas or sore spots in any of the muscles of the shoulder girdle.. If you make them go away. So does the Frozen Shoulder. Thats my experience.   I like to get people with frozen shoulder.  I get excitted.. Because I know I can help them. And if they have been seeing PTs, Im even more excited.. lol

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Permalink Reply by Lynn Wilder-Burrett on December 30, 2012 at 10:23pm

Gordon,... are those screenshots from the Real Bodywork Muscle Trigger Point Anatomy app?  I have an Android but it looks the same as mine.

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Permalink Reply by Gordon J. Wallis on December 31, 2012 at 4:11am

Yea , I have an android tablet, Im using it now.. Dont worry about pain patterns..just palpate from T12 up, front back and side for sore spots.. with more attention to all those shoulder muscles. Take note of them.. eliminate them.. OH I thought I was talking to the person that asked the question... lol   I use it to show clients sometimes or for talking in here.

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