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Evaluation and Treatment of the Shoulder Complex: Summary
Shoulder Complex: Components of Examination Posture Posture can give basic information about muscle balance and imbalance . If a patient presents with shoulder internal rotation and scapular protraction muscles, an anterior aspect is tighter compared to a posterior aspect, and posterior muscles will be weaker compared to anterior muscles. Research shows that posture is an outward expression of mental status.
The neurofascial system is altered by injury. An injury creates faulty sensory information because of the change of tone in the injured muscle. Change in tone can change proprioception and over time can create movement dysfunction. Over time, the brain will recognize the abnormal movement pattern and will begin to recognize it as normal. Typically, when an individual performs an activity for greater than 6 weeks, the brain internalizes it as habit or normal function. Neurological research has shown that in as little as 7 to 10 days, an abnormal movement pattern can be recognized as normal by the brain.
Posture Assessment • Forward head posture: Compensatory mechanism due to spinal changes in the thoracic and lumbar regions. • Scapula protraction/shoulder IR: Caused by increased kyphosis; if there is tightness in the rectus abdominis, the patient is pulled into increased trunk flexion/increased thoracic kyphosis. • Lumbar hyperlordosis: Caused by anterior pelvic tilt. • Knee hyperextension: Caused by anterior shift of the head of the femur; also results in anterior pelvic tilt. • Ankle plantarflexion = tibia falls posteriorly → tight gastrocnemius. Active Range of Motion and Passive Range of Motion • Active range of motion (AROM) assessment
LEARNING TIP! Overhead reach assessment Overhead reach screens: cervical posture, shoulder flexion and abduction mobility, thoracic mobility, and lumbopelvic stability.
○ If active range of motion is restricted, then shoulder passive range of motion (PROM) should be assessed. PROM will eliminate muscle and strength component of motion. Active and passive ROM restriction indicates a tightness issue. If active and passive ROM are restricted (indicating a tightness issue), this could be due to the joint capsule, the fascia, tightness
in the muscle, or never mobility. Restricted AROM with full PROM indicates a weakness issue
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