Massage & Bodywork

November/December 2009

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THE GLENOHUMERAL JOINT Frozen Shoulder, Part I The arm needs to move. Reaching, lifting, pulling; hanging, swinging, pushing —the motions of daily life depend on a mobile shoulder. In this first of two articles, we'll discuss ways to assess and restore lost motion to the glenohumeral joint, using techniques taught in Advanced-Trainings.com's Advanced Myofascial Techniques seminars. In order to get the mobility the shoulder needs, the boney socket of the shoulder joint (the glenohumeral fossa) is quite shallow. Instead of relying on a deep socket like the acetabulum of the hip, the shoulder gets stability from the soft tissues around the joint—the joint capsule and ligaments (Image 1), as well as the muscles of the rotator cuff (which we'll talk about in the next article). These soft- tissue structures allow the necessary balance of stability and movement, yet are vulnerable to injuries and strain, which can cause these structures to restrict movement instead of allowing and supporting it. Glenohumeral abduction, or bringing the arm out to the side, is often the first movement to show inhibition when the soft tissues of the shoulder joint have With palpation, you should feel the greater tuberosity (GT) of the humerus move inferiorly (arrow) with arm abduction. When this inferior glide is lost, the greater tuberosity will ride up into the acromion (a), limiting abduction. Image courtesy Primal Pictures. Used with permission. lost mobility. Often, when abduction has been lost, it is linked to a loss of inferior glenohumeral glide. INFERIOR GLIDE OF THE HUMERUS ASSESSMENT Try this: raise your arm out to the side, while you use your other hand to feel what happens at greater tuberosity of the humerus, the most lateral boney protuberance of the shoulder. In a healthy shoulder, you'll feel this boney prominence drop out from under your touch (move inferiorly) as the arm starts to abduct (Image 2). This is because the head of the humerus glides inferiorly in the glenohumeral joint as the arm abducts. This inferior motion will be most apparent upon the initiation of arm movement—just check the first inch or two of movement. There is a long list of possible causes of lost inferior glide—shortness or restriction in the deltoid, supraspinatus, or joint capsule; injury, inflammation, impingement, or adherence of ligaments, bursa, labrum, or capsule membranes. These most often relate to injuries, posture, and strain, although sometimes there is no apparent primary cause for a loss of shoulder movement and glide. Whether the cause can be easily determined or not, when inferior humeral glide is lost, the humerus rolls connect with your colleagues on massageprofessionals.com 119

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