Incorporating OMM to Enhance Your Clinical...
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Incorporating OMM to Enhance Your Clinical Practice
Osteopathic diagnosis and approach to the upper extremity
Sheldon C. Yao, D.O. Acting Department Chair
March 1, 2013
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Clinical significance • Upper extremity problems are common due to
the need for mobility there is decreased stability and increased risk of injury.
• MSK pain can be treated with OMT. • Nerve impingements can also be potentially
relieved with treatment. • OMT has been shown to reduce pain, improve
functionality, and decrease need for pain medications.
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Evaluation - Feel 1. Bony landmarks - Sternum - Clavicle - S-C and A-C joints - Scapula - medial and
inferior borders, spine, acromiom, coracoid process.
- Humerus – greater and lesser tubercles, bicipital grooves
- Thoracic cage
2. Muscles -check for tone, atrophy,
tenderness. 3. Tendons - Long head of biceps - Supraspinatus-at tip of
acromiom.
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Evaluation - Move
• Flexion -180 degrees • Extension -45 degrees • Abduction -180 degrees • Adduction - 45 degrees • Internal Rotation - 55 degrees • External Rotation - 45 degrees
Range of Motion Testing
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Somatic Dysfunctions associated with shoulder pain
• Commonly affects clavicular articulations. • May significantly restrict shoulder girdle
motions. • Check for dysfunctions above and below the
affected joint. • Treatment - must assure free motion at the
scapulothoracic area and at the accessory joints.
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Adhesive Capsulitis (Frozen Shoulder)
• Caused by Disuse / Immobilization
• Inflammatory process • Seen in tense people
with low pain threshold • Prevention is most
important. • Increased risk with
diabetic patients
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Osteopathic considerations in Adhesive Capsulitis
• Application of MET is useful in helping to restore muscles to proper length and remove restrictions of motion.
• Spencer’s technique (an articulatory technique) is designed to increase ROM of the shoulder.
• Treatment of gleno-humeral dysfunctions, rib, clavicle, and thoracic dysfunctions will also improve ROM.
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“Scapulothoracic Joint”
• Scapulothoracic – Between the anterior
surface of the scapula and the ribs, with muscle and fascia between the bony surfaces.
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Functional Mechanisms • Scapulohumeral rhythm-during abduction,
the scapula rotates upwards as the humerus elevates.
• For each 15 degrees of motion, the humerus accounts for 10 degrees while the scapula accounts for 5 degrees.
• This avoids impingement of the humeral head w/ the acromium, and supports the humerus in glenoid fossa against the effects of gravity.
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Biceps Tendonitis • Inflammation or degenerative changes of the
tendon of the long head of the biceps • Usually due to overuse or repetitive trauma • Sign: + Yergason’s test • Medical Management: Rest, ice, lidocaine,
steroid • Osteopathic Management:
– Free up restrictions in the glenohumeral area – Myofascial release – Counterstrain technique for the bicep tendons
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Anterior Shoulder CS Points
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Posterior Shoulder TP
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Spencer’s Technique • Extension • Flexion • Circumduction • Circumduction with
traction • Abduction
(adduction) • Internal rotation • Traction
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Palpation/Motion of Radial Head
• Thumb is on anterior-lateral portion • Index finger on postero-lateral
portion a) supination/pronation motion b) Translatory anterior-posterior motion
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Radial Head Diagnosis
1) Palpate radial head 2) Move through pronation 3) and supination 4) Anterior/posterior glide
Diagnosis: Anterior Radial Head • Glides more easily
in anterior direction • Restriction in
posterior glide • Forearm supination
freedom • Pronation
restriction • May be “adducted’
elbow
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Radial Head Diagnosis
1) Palpate radial head 2) Move through pronation 3) and supination 4) Anterioro/posterior glide
Diagnosis: Posterior Radial Head • Glides more easily in
posterior direction • Restriction in
anterior glide • Forearm pronation
freedom • Supination
restriction • May be “abducted’
elbow
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Median Nerve C6-C8
• Fine control of the pincer grip
• Extrinsic flexors of the hand
• Intrinsic thenar muscles
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Carpal Spread