Shoulder Medial Rotation

Excessive humeral medial rotation or insufficient lateral rotation is noted during shoulder flexion and abduction.  The shoulder medial rotators dominate over the lateral rotators. (Sahrmann, 2002)

SYMPTOMS & HISTORY

ASSOCIATED WITH IMPINGEMENT

  • Pain most often in anterior shoulder but may also be posterior shoulder or deltoid
  • Pain with overhead activitiesor with activities involving shoulder rotation w/arm elevated
  • Unable to sleep on affected side

ACTIVITIES

  • Weight lifters
  • Heavy laborers
  • Swimmers

KEY TESTS & SIGNS

ALIGNMENT AND APPEARANCE

  • Humerus is medially rotated w/wout corrected scapular alignment

MOVEMENT IMPAIRMENTS

  • Excessive humeral medial rotation noted during shoulder flexion and abduction
  • Correction of excessive medial rotation may lessen pain
  • May increase pain if capsular structures are shortened leading to increased compressive forces (e.g. superior glide)

SPECIAL TEST

  • Accessory joint motion can be decreased posteriorly

IMPAIRMENTS IN MUSCLE LENGTH

  • Based on length tests:  short medial rotators (e.g. teres major, latissimus dorsi, pectoralis major)

IMPAIRMENTS IN MUSCLE STRENGTH

  • Weak lateral rotators

ASSOCIATED SIGNS

ALIGNMENT AND APPEARANCE

  • May have normal resting alignment
  • Humerus may be abducted
  • Forward shoulder (abducted or tilted scapulae)
  • Obesity

STRUCTURAL VARIATIONS

  • Generalized muscle bulk
  • Wide thorax
  • Barrel chest
  • Commonly assoc w/scapular syndrome

MOVEMENT IMPAIRMENTS

  • Shoulder flexion
  • Assoc w/impingement:  may have slight end-range limitation and may have painful arc
  • Assoc w/instability:  during shoulder flexion see a sudden shift of humerus into medial  rotation

IMPAIRMENTS IN MUSCLE LENGTH

  • Short or stiff deltoid
  • Short lateral rotators

IMPAIRMENTS IN MUSCLE STRENGTH

  • Weak subscapularis assoc w/ impingement

PALPATION

  • May be tender over coracromial lig., bicipital groove, or rotator cuff tendons (supraspinatus)

SPECIAL TESTS

  • Impingement tests:  reproduce pain; resisted tests of rotator cuff and biceps for soft tissue diff dx may be strong/weak painful

DIFF MVMT & ASSOC DX

DIFFERENTIAL HUMERAL DIAGNOSIS

  • Rule:  if shoulder medial rotators and superior glide co-exist, superior glide is dx

DIFFERENTIAL PRIMARY DIAGNOSIS

  • Scapular downward rotation
  • Scapular depression
  • Scapular abduction
  • Scapular winging and tilting

ASSOCIATED DIAGNOSES

  • Rotator cuff tendinopathy
  • Shoulder impingement
  • Partial rotator cuff tear
  • Bicipital tendinopathy
  • Supraspinatis tendidopathy
  • Bursitis
  • Ac joint pain
  • Calcific tendinopathy

MED DX REQ. REFERRAL

MUSCULOSKELETAL ORIGIN

  • Cervical radiculopathy
  • Brachial plexus injury
  • Rotator cuff tear
  • Fracture
  • Oa or ra
  • Glenoid labrum tear

VICERAL ORIGIN

  • Neoplasms
  • Cardiovascular disease
  • Pulmonary disease
  • Breast disease
  • Abdominal organ pathologic condition

SYSTEMIC ORIGIN

  • Collagen vascular disease
  • Gout
  • Syphlis and gonnorhea
  • Sickle cell anemia
  • Hempohilia
  • Rheumatic disease

MOVEMENT TX

PRIMARY EMPHASIS

  • Improve control of humeral lateral rotators
  • If medial rotators are short they must be lengthened
  • If teres major is short must be lengthened…must restrain scapula during shoulder flexion
  • Improve control of gh lateral rotators (with resistive exercise) to maintain picr
  • Scapula should not wing/tilt during  prone lateral rotation w/shoulder abducted to 90  and elbow flexed to 90… Only the humerus should move
  • Teach shoulder packing…contracting scapular adductors and serratus anterior while minimizing the contribution of the gh lateral rotators

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s