Massage & Bodywork

September | October 2014

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100 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 technique CLINICAL APPS Upper margins of the glenohumeral joint capsule. Image is from 3D4Medical's Essential Anatomy 3 application available on the App Store. 1 Upper margin of the joint capsule Emily's Nerve Traction Injury By Whitney Lowe Injuries are sometimes fairly straightforward. Examples of a straightforward injury might be a medial collateral ligament injury in sports or carpal tunnel syndrome from repetitive overuse. However, many times injuries require more detailed biomechanical analysis to determine what actually occurred and whether massage would be helpful. In this installment of Clinical Apps, we take a look at a unique injury condition affecting the shoulder and upper extremity. THE CASE Emily has a large dog, Boomer. Several weeks ago, while walking her dog, Emily had stopped to talk to a neighbor when Boomer abruptly lunged after a squirrel. The leash was firmly wrapped around her right hand, and because she was caught completely off guard, she was pulled off her feet and hit the ground pretty hard. She doesn't remember exactly how she landed, but remembers Boomer was on her right, so her right arm was stretched out to that side. Emily also reports that she was looking to the left when Boomer lunged after the squirrel. She remembers feeling a sharp pain on the right side of her neck and pain shooting down her right arm immediately after the accident. The pain was worse the next day. It has been two weeks since the initial injury and Emily now wants to see if treatment can help her resolve the lingering issues. ANATOMICAL CONSIDERATIONS Emily continues to have significant shoulder pain and also reports a sharp, shooting pain down her right arm. There is no visible sign of injury in Emily's neck, shoulder, or upper extremity regions. Consequently, it will be very important to get more detailed information from her about the initial injury to determine what tissues were likely injured. There are several high-intensity forces that could be directly related to Emily's present complaints of shoulder and arm pain. The foremost is the sudden pulling or traction injury on the shoulder. It's quite likely that some of the rotator cuff muscles were injured in this incident because of their key role in stabilizing the humeral head. As evidenced in the name, the rotator cuff muscles' primary role is shoulder rotation, and they are also involved in supraspinatus abduction. The attachment sites of the four muscles form a cuff around the top of the humeral head. By enclosing the entire humeral head, these short muscles pull it closer into the glenoid fossa.

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