26
26
Evaluation and Treatment of the Shoulder Complex: Summary
The posterior fascia is composed of three layers, as opposed to other areas of fascia, which are typically composed of two layers. The posterior fascia associated with the shoulder complex encapsulates the scapula, erector spinae, and latissimus dorsi, which are also all components that help create the posterior functional line (image B). The portion of the posterior fascia known as the thoracolumbar fascia can thicken over time with chronic pain. Subsequently, this thickening results in additional pressure on encapsulated nerves. These nerve types include nociceptors, which are responsible for pain; proprioceptors, which are responsible for postural changes; and mechanoreceptors, which can cause altered recruitment patterns with encapsulation. In all, it is important to note and assess for instability of the lumber spine, as this can result in abnormal movements of the shoulder complex. Nerves of the Shoulder Complex Nerve Axillary nerve (posterior neurovascular bundle) Musculocutanous nerve (part of the anterior neurovascular bundle)
Restrictions anywhere within the anterior and posterior functional lines can result in dysfunction anywhere along the lines. Innervation within the shoulder complex include the axillary nerve (coming off the brachial plexus) and the musculocutaneous nerve. Image B: Posterior Functional Line
Innervation/Function
• Teres minor • Deltoid
• Coracobrachialis • Biceps brachii • Brachialis • Sensory input to anterior humerus
• Supraspinatus • Infraspinatus
Suprascapular (posterior neurovascular bundle)
• Subscapularis for motor function, as it is the primary shoulder IR
Subscapularis
• Forearm
Median (part of the anterior neurovascular bundle) Ulnar (part of the anterior neurovascular bundle)
• Forearm
• Posterior aspect of the arm includes triceps brachii (attach scapula and perform shoulder extension)
Radial (posterior neurovascular bundle)
Powered by FlippingBook