Oct 24, 2011

Technique Highlight: Subscapularis Release

Dysfunction in the subscapularis can be seen in

  • shoulder impingement patients
  • AROM with a painful arc
  • frozen shoulder
  • patients who have been wearing a sling long enough for adaptive shortening of the internal rotators
  • any patient with limited ER or elevation

This is an older video, showing a progression of forces and functional movement based releases for the subscapularis. I also review lateral upper arm release to effectively work on two of the more common upper quarter patterns of dysfunction. You can use the lateral upper arm release on patients who are limited by pain and or post-op protocol, then progress them to the functional subscapularis release once they are no longer limited.





6 comments:

Tim Richardson, PT said...

Be careful that you don't use too much force - the Long Thoracic nerve is superficial to the subscapularis on its ventral aspect.

The Long Thoracic is usually described as a pure motor nerve and damage (neurapraxia) to the nerve or rupture (neurotmesis) may go undetected once the acute, injury phase is resolved.

No sensory fibers are available to signal damage and te traditional hallmarks of peripheral nerve injury, such as tingling or numbness, may not alert the therapist.

Paralysis of the Serratus Anterior is the expected outcome of damage to the Long Thoracic nerve.

Loss of Serratus Anterior force production can be detected by asking the patient to flex or abduct their arm and observe for "scapular winging".

Tim

Dr. Erson Religioso III, DPT, MS, FAAOMPT said...

Thanks Tim! I remember the long thoracic nerve from Gross Anatomy, took me hours to dissect out properly only to have my roommate cut it out the next day! According to Butler, the nervous system can handle loads, compressions, and deformations. The progressions in the video I show are to be used over the course of several treatments. I will use serratus testing as my pre and post test functional measure in addition to my active and passive testing.

Scott McClure said...

Very informative...I have been a paramedic for almost 23 years and have had 3 shoulder surgeries over the past 8 years..most recent was Mayu 30, 2012. I reinjured my right shoulder on Oct. 30th while caring for a combative psych patient. He hyperextended the shoulder and it appears I have torn the subscap. I go to my surgeon tomorrow for the "verdict" on the arthrogram I recenrly had done. Thanks for the "laymans" descriptions you have posted...made it alot easier to explain the injuy to my parentooms! Keep up the great work!

Dr. Erson Religioso III, DPT said...

No problem! Best of luck with your shoulder!

ben loh said...

great post doc. I'm in third year chiro and am kinda confused abt all this muscle action. I know subscap is an IR of the shoulder. Hence, if you do a liftoff test and there is pain, it suggests a subscap injury, which would then restrict IR motion (eg. hands behind back to reach medial border of the scapula). erm is this correct?
However, reciprocal inhibition would suggest that tight ext rotators (eg. infra) would limit IR of the shoulder? then how would you differentiate the real cause of restricted IR? sorry for the dumb questions!!

Dr. Erson Religioso III, DPT said...

This is a tough question because the "real cause" may be many things, but not normally muscles per se. Muscles are not often tight, but may have increased tone. Most of the soft tissue releases with hands or tools change tone and superficial skin movement on the first layer of fascia but that's about it. This is why I only assess movement via repeated motions and or the SFMA and not special tests designed to tell you something about a structure.

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