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August Newsletter
Erik Dalton, PhD, Certified Advanced Rolfer
Life is good! Tropical storm “Chris” was headed for Boca Raton, Florida last weekend and so were we…but we scared him off. The annual workshop sponsored by TakeMyRegistration.com was lots of fun for both staff and the 48 attending participants. In two weeks (August 26-27) we head for the exciting little vacation city of Reno, Nevada (bordering Lake Tahoe). I look forward to seeing you in our Myoskeletal (Neck, Shoulder, Arm, and Back) workshop at the beautiful Atlantis Casino Resort and Spa.
In our last issue, we began a tour of the upper extremities with a general discussion of proper shoulder girdle mechanics while emphasizing the importance of establishing full range of motion in all associated joints. This issue continues with assessment and treatment modalities for bony articulations of the shoulder, arm and hand beginning with one of the most important and oft-overlooked structures of the shoulder girdle complex….the sternoclavicular joint. But first--a short refresher on shoulder girdle musculature.
The label “shoulder complex" appropriately describes the complexities encountered when dealing with pain in this commonly dysfunctional area. Comprised of three joints and one primary articulation, the bones are moved by a complex array of twenty muscles that when functioning properly; permit the greatest mobility of any joint in the human body. The three primary muscles supporting the shoulder complex are pectoralis minor, subclavius, and teres minor -- but don't let the names fool you. They are neither substandard nor minor in their effects on the shoulder. Clearly, these pivot muscles set the position of the shoulder so that larger muscles with greater leverage such as the lats, traps, pects, and delts can perform gross movement of the shoulder and arm. However, when underlying core pivot muscles spasm, form fascial contractures, or become too lax, compensations occur which create muscle imbalances and strain patterns that compress and torsion associated joints. The resulting tissue damage results in increased protective muscle guarding and the formation of neurologic pain/spasm/pain cycles. This ultimately leads to a wide array of shoulder problems, the exact nature of which depends on each individual's patterns of use.
Running parallel to the collarbone from the first rib, the primary purpose of subclavius appears to be stabilization of the loose-fitting sternoclavicular joint, although most texts refer to it as a depressor of the clavicle. It is important that therapists not underestimate the importance of these small stabilizing pivot muscles. Their duties are less about the movements they create than the movements they prevent. For example, when subclavius contracts its stabilizing effect not only prevents dislocation of the shallow saddle of the sternoclavicular joint, but also limits excessive clavicular elevation. Any micro or macro traumatic event that restricts SC joint range of motion will facilitate or inhibit neighboring muscles causing asymmetrical arm and hand functioning.
Muscle/ Joint Mechanics
The sternoclavicular joint (SC) provides the only firm attachment for the upper extremity to the axial skeleton. Because it functions as a saddle joint, it can allow for clavicular motion in horizontal abduction/adduction and elevation/depression.
Recall that the SC joint always moves in opposing directions to the scapula. Therefore, shrugging of the shoulders should cause the medial heads of the clavicle to drop down. This configuration produces proximal clavicular depression during arm elevation. So to test, the therapist simply places her fingers on top of the medial clavicular heads and asks the client to shoulder-shrug. If one side does not drop down, there is restriction in the surrounding myoskeletal tissues (muscle, ligament, fascia, disc, or bone).
CLAVICULAR ELEVATION AND DEPRESSION OCCUR AROUND THE JOINTS A-P AXIS
The joint's AP axis is a line that connects two points (indicated on the figure by filled circles):
The second and most common restriction seen at this very mobile joint occurs during horizontal flexion of the shoulders. To test, the therapist stands on the client’s right side with the left hand on the client’s back and places his right thumb and index finger on the anterior surface of the medial clavicles (tall people should be seated when performing these assessments). With the index finger and thumb monitoring the anterior clavicular surfaces, the client is instructed to lift arms to 90 degrees and reach forward causing horizontal flexion of the shoulder girdle. The therapist’s finger and thumb should palpate the medial heads translating posteriorly during this maneuver. If one or both sides do not move back, the restriction can alter range of motion in the acromioclavicular and glenohumeral joints.
CLAVICULAR PROTRACTION AND RETRACTION OCCUR AROUND THE JOINT'S VERTICAL AXIS.
Anterior movement of the clavicle's distal end is termed "protraction," while posterior movement of the distal end is termed "retraction."
Figure 1 demonstrates a very effective technique for restoring range of motion for a medial clavicular head fixation that refuses to move posteriorly during horizontal flexion. Thoracic outlet syndrome, rotator cuff tears and frozen shoulders commonly originate with SC joint fixations.
Therapist places his right hypothenar eminence on motion-restricted medial clavicle and left hand under scapula. Client’s right hand grasps therapist’s neck and gently pulls against therapist’s resistance to a count of five and relaxes. Therapist’s left hand flexes shoulder girdle as right hand depresses stuck right clavicle. Repeat three times to restore posterior clavicular glide at SC joint.
In the September e-Newsletter, we’ll explore the three primary movements available at the acromioclavicular joint and demonstrate how range of motion restrictions here can create pain and protective muscle guarding in associated soft tissue structures. So, have a great Labor Day and keep up the good work!
Visit www.Orthomassage.net for details on the upcoming Seminars At Sea cruise with James Waslaski, Aaron Mattes and Cliff Korn.
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