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Orthopedic Assessment

Tips for finding the root cause of the injury

Home » Orthopedic Assessment

A Simple Shoulder Assessment

Submitted by on June 1, 2009 – 10:04 amNo Comment

I’d like to share with you a simple technique to assess if the scapular movement is to blame in a painful shoulder.

Let’s say you have a client who comes in for a sports massage complaining of shoulder pain.  They state they have pain when they raise their arm overhead in either full shoulder flexion or abduction (remember the difference?  Flexion is raising the shoulder forward & abduction is raising it out to the side).

The first step is to have your client lie supine (face up) on the massage table.  This will stabilize the back and eliminate any compensatory movement.  Now have them slowly raise their arm fully overhead in shoulder flexion.

If they experience pain with this movement, you then have them return their arm to the starting position.  They will repeat the motion, but this time you will assist their scapula in its normal movement.  Sit or kneel at the side of the table and slide one hand under the lower part of the client’s scapula, hooking your fingers as best you can on the medial (vertebral) border.  Now instruct the client to raise their arm overhead once more, but as their shoulder flexes, gently pull their scapula into abduction and outward rotation.  Chances are good that the pain will be reduced or eliminated completely.

Assist Scapular Motion

Assisting Scapular Motion

Why?  Because a significant percentage of shoulder injuries are due to scapular movement dysfunction.  In a previous post, I mentioned that the scapula needs to abduct and rotate outward when the shoulder flexes or abducts.  When the scapula cannot properly move, the glenohumeral joint will try to increase its movement to compensate for the loss, leading to impingement of the supraspinatus tendon or other soft tissue under the acromion.

Working at the site of the pain will simply be treating the symptom, and the client will not show significant improvement until the supporting musculature are addressed.

So, if you find yourself with a client who fits this scenario, you need to work on releasing the muscles that prevent the abduction and external rotation.  Namely, the levator scapula, pectoralis minor and rhomboids.  In addition, these clients will often show weakness in the serratus anterior muscle, which has the job of scapular abduction and outward rotation.

You can also use the assessment test as a means of training the client’s muscles to fire correctly.  Simply have them perform slow, full shoulder flexion while you assist the scapular movement into abduction and outward rotation.  Over time, these repeated movements will re-educate the muscles (and nervous system) to how active they should be during shoulder flexion.  Just be sure this movement remains pain-free!


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