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Anatomy related questions(humerus cannot medially rotate)

Hi all,

I have a question regarding a client of mine that I have been seeing for several weeks.

She came to see me because of her right sided "Frozen Shoulder" condition. Basically she cannot raise her right arm above shoulder level.

Two things happen: Her scapula is not "engaging" and her supraspinatus seems to be weak, i.e., MRI showed signs of tearing in tendon attaching supraspinatus to acromion. She also has fibrousness/scar tissue buildup around the head of her humerus and posterior deltoid.

Upon evaluation I noticed her scapulae are pulled laterally and seem to "wing" quite a bit. When she is laying down her scapula is pulled anterior(Towards her front) and laterally (away from spine).

I also noticed her humerus has trouble medially rotating. 

My protocol so far has been to relax the tissues in the front (pec major, pec minor) that may be pulling on, and "locking-long" her rhomboids and causing her scapula to wing. I've also been working her sub-scap and peeling her shoulders back around to a more medial position, BUT, her scapula is VERY frozen even with some intense work.

I've been having her do some stretches for her pectoralis and subscap, and I have been having her strengthen her rhomboids and supraspinatus. Does this seem like a reasonable protocol to free up her shoulder and scap?

Basically my question is to anyone that has seen some frozen shoulder clients who have trouble medially rotating their humerus and a frozen scapula what course of treatment seemed to worked the best?

Thank You,

B

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Permalink Reply by Gordon J. Wallis on December 23, 2012 at 3:32am

My perspective, and I help people all the time with shoulder problems.. I dont have to think about trying to change structure..Bringing this around and that.. And you said there was a tear on the Supraspinatus. If you strengthen tht you will cause more damage.  I simply palpate for tender spots with the help of my client... find them , then down grade them or eliminate them.  If you are able to do that.. all the injured muscles will go back to their normal resting state...Those sore tender areas are trigger points... contracted muscle fibers.. They shorten the length of the muscle and cause it be weak.. They are weak because they are injured.. The worst thing to do is strengthen them.. Eliminate the sore spots and you will get clinical results.. The muscles will go back to a balance by themseles..  And i dont advise stretching injured muscles.. let them rest... he should not even stretch afterwards.. The tissues need to rest and heal.. Thats what I do..   And I just did it today...Im going to make a brief comment on it in another thread.. you might want to read it.  Im just telling you what  I do. 

Permalink Reply by Jody C. Hutchinson on December 23, 2012 at 9:44am

BZ,

A frozen shoulder can take months to resolve.  I would also examine the serratus anterior-another cause of scapular winging and the deltoid.  If there are rotator cuff tears, they heal very slowly.  Think of something that's frozen, it needs to thaw out. Check out Whitney Lowe's articles about frozen shoulder, they are very informative.

Cheers,

jh

Permalink Reply by Brendan Zachar on December 23, 2012 at 11:55am

Thanks for the thought out responses. Could i get a link to those Frozen Shoulder articles by chance?

Permalink Reply by Gordon J. Wallis on December 23, 2012 at 1:10pm

I have never ever had a frozen shoulder that took months. Never ever. If there is no serious joint damage, in which case it will never get resolved without surgery.  it just takes a few sessions.  I mean really.  But no one has to believe me. lol

Permalink Reply by Gary W Addis, LMT on December 23, 2012 at 8:22pm

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. 

Permalink Reply by Gordon J. Wallis on December 23, 2012 at 10:40pm

Ok, talk about frozen shoulder.    I had a women today that was or is diagnosed with frozen shoulder by  an MD, and confirmedd by physical therapists.. ok...  got that.... I work in a spa... She came in for   QUOTE  relaxation massage..She has been treated by physical therapists for 4 and a half months... She was in so much pain...they prescribed her a pain patch.. her pain was so sevier that she cant sleep at night... Her therapy is painful.. she hurts worse after her therapy.... Thats because the idiots have her doing the exact opposite of whats needed...She could not abduct her arm without pain in any direction... After her one hour massage.. Her pain was  gone... Totaly,, and she had full range of motion...Its unbelievable to me... This is not an isolated case...Im so pissed off right now... She has had Thousands of dollars of uselles debilitating therapy for months...I fixed her for $45 fing dollars.. an Fing joke.. I will attach pictures of her so called frozen shoulder, after I write this... She said ..   Im trying to process what you just did?? I have been so serious with my physical therapy....I have no pain now... Im trying to process  what you did.... I have no pain now...    She was shocked... Im pissed off... Its a joke.. Iwill post pictures of her problem right after this... Im pissed because its like this all the time...They told her she might need surgery... What a joke... She  told me in front of her husband.. That she is excited and will not go back to physical therapy.. she will see me again for one more follow up after Christmass.. a 25 min. massage .. Forzen shoulder... NOT

Permalink Reply by Gordon J. Wallis on December 23, 2012 at 10:44pm



Gordon J. Wallis said:

Ok, talk about frozen shoulder.    I had a women today that was or is diagnosed with frozen shoulder by  an MD, and confirmedd by physical therapists.. ok...  got that.... I work in a spa... She came in for   QUOTE  relaxation massage..She has been treated by physical therapists for 4 and a half months... She was in so much pain...they prescribed her a pain patch.. her pain was so sevier that she cant sleep at night... Her therapy is painful.. she hurts worse after her therapy.... Thats because the idiots have her doing the exact opposite of whats needed...She could not abduct her arm without pain in any direction... After her one hour massage.. Her pain was  gone... Totaly,, and she had full range of motion...Its unbelievable to me... This is not an isolated case...Im so pissed off right now... She has had Thousands of dollars of uselles debilitating therapy for months...I fixed her for $45 fing dollars.. an Fing joke.. I will attach pictures of her so called frozen shoulder, after I write this... She said ..   Im trying to process what you just did?? I have been so serious with my physical therapy....I have no pain now... Im trying to process  what you did.... I have no pain now...    She was shocked... Im pissed off... Its a joke.. Iwill post pictures of her problem right after this... Im pissed because its like this all the time...They told her she might need surgery... What a joke... She  told me in front of her husband.. That she is excited and will not go back to physical therapy.. she will see me again for one more follow up after Christmass.. a 25 min. massage .. Forzen shoulder... NOT

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Permalink Reply by Gordon J. Wallis on December 23, 2012 at 10:46pm

Imagine if all those trigger points were gone.. How would your shoulder feel?   Pluss  she had a very painful Piriformis TP along with a very painful L4 spinal errector Tp...All those are gone now. Of course she feels no pain...  TRUTH REMAINS HIDDEN.  Whatever.

Gordon J. Wallis said:



Gordon J. Wallis said:

Ok, talk about frozen shoulder.    I had a women today that was or is diagnosed with frozen shoulder by  an MD, and confirmedd by physical therapists.. ok...  got that.... I work in a spa... She came in for   QUOTE  relaxation massage..She has been treated by physical therapists for 4 and a half months... She was in so much pain...they prescribed her a pain patch.. her pain was so sevier that she cant sleep at night... Her therapy is painful.. she hurts worse after her therapy.... Thats because the idiots have her doing the exact opposite of whats needed...She could not abduct her arm without pain in any direction... After her one hour massage.. Her pain was  gone... Totaly,, and she had full range of motion...Its unbelievable to me... This is not an isolated case...Im so pissed off right now... She has had Thousands of dollars of uselles debilitating therapy for months...I fixed her for $45 fing dollars.. an Fing joke.. I will attach pictures of her so called frozen shoulder, after I write this... She said ..   Im trying to process what you just did?? I have been so serious with my physical therapy....I have no pain now... Im trying to process  what you did.... I have no pain now...    She was shocked... Im pissed off... Its a joke.. Iwill post pictures of her problem right after this... Im pissed because its like this all the time...They told her she might need surgery... What a joke... She  told me in front of her husband.. That she is excited and will not go back to physical therapy.. she will see me again for one more follow up after Christmass.. a 25 min. massage .. Forzen shoulder... NOT

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Permalink Reply by Therese Schwartz on December 23, 2012 at 10:59pm

Hey Gordon - I'm sorry you are so pissed off.  I can totally understand it!

I hope you have a chance to relax over Christmas, and enjoy a bit of down time.

Permalink Reply by Gary W Addis, LMT on December 23, 2012 at 11:44pm

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.

Permalink Reply by Therese Schwartz on December 24, 2012 at 12:41am

We might have a snowy Christmas here in OK too!  As is always the case in OK, the weather predictions are mostly guesstimates.  I'd love some of your hard rain - we are several feet behind over the last 2 years.

I'm sorry you have the flu!  It's going around here too.  And that stinks about Gordon's phone.  Really, I wonder about humanity at times.

Hopefully everyone will find some joy, no matter what.

Permalink Reply by Gordon J. Wallis on December 24, 2012 at 1:32am

Im fine.  Im drinking a beer now.. lol

Therese Schwartz said:

Hey Gordon - I'm sorry you are so pissed off.  I can totally understand it!

I hope you have a chance to relax over Christmas, and enjoy a bit of down time.

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