Monday, December 11, 2006

Common Shoulder Dysfunctions

Common Shoulder Dysfunctions

Posterior shoulder musculature

(rotator cuff).

Anterior shoulder musculature.

Notice the intimate relationship between the scapula and the rib cage. If the ribs and spine suffer from neuromuscular dysfunction, there is no way that the shoulder joint can’t be affected.

Shoulder problems are interesting and one of my favorite regions of the body to treat. One of the things that many health care providers fail to realize is the underlying cause of the degenerative processes that lead to eventual tissue failure. There is no reason that computer use would cause any more detrimental force than any other activity, on the contrary I would say just the opposite. Now if this is the primary activity of the involved shoulder then we have other considerations, such as progressive weakening, adaptive shortening of contractile tissues and an increase in fibrosis changes at the cellular level. All of these things can happen from disuse and misuse, or as a result of neuromuscular dysfunction. I find that the majority of people who suffer from a torn rotator cuff, tendonitis or other chronic irritations of this incredible joint have the latter, neuromuscular dysfunction (NMD).

So what is NMD? It is a reflexive disorder of the body's built in soft tissue and joint injury defense system. In the shoulder is it most often present as upper thoracic spine dysfunction and associated costal cage dysfunction (ribs). This may sound strange, especially if you are like most people and tend to think of problems and the pain one feels as the same thing. In reality, the pain is usually not the problem, only a symptom of the dysfunction. The ribs, especially the top 5 are crucial to the functional integrity of the scapulothoracic joint (articulation of the scapulae and posterior costal cage). In most cases of shoulder NMD the contour of the ribs is uneven. A single rib or two that become elevated (posterior aspect of rib) and/or depressed (anterior aspect) can result in structural compensation of the entire shoulder girdle. The shoulder girdle is comprised of all of the 4 joints in the shoulder and all of the scapular and glenohumeral (true shoulder joint of upper arm and shoulder blade) musculature. When this happens there is a marked increase in the demands (load) placed on the muscles of the rotator cuff, especially the supraspinatus muscle. The rib dysfunction essentially causes a migration of the shoulder blade towards the front of the body and tilts the shoulder blade up and forward. This causes a marked increase in the stretch applied to the shoulder muscles in the back and a marked shortening of the shoulder muscles in the front. This looks like your typical poor, slouched posture, but has nothing to do with ones conscious ability to affect posture; it has everything to do with the bodies' reflexive protective spasm response to inappropriate nerve signals from our muscle and connective tissues. In some cases, the spine will not be bent forward; it will actually be in an extreme upright position. This is equally troublesome because it interferes with the mechanics of the scapulae and ribs by causing the same type of disturbance in the costo-vertebral joints (place where the rib attaches to the spine) found in the forward bent spine.


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