Dr. Vladimir Janda (1928)-(2002) simplified assessing commonly occurring upper body postural distortions and problems by defining upper crossed syndrome. According to Janda, when some muscles are placed under stress they become tight. These muscles include pectoralis major, pectoralis minor, subscapularis, sternocleidomastoid, anterior scalenes, upper trapezius, levator scapula, and the suboccipitals.
When other upper crossed muscles are placed under the same stress they become weak and inhibited. These muscles are rhomboids, middle and lower trapezius, infraspinatus, teres minor, and neck flexors.
To alleviate chronic upper body pain patterns, every therapist should attempt to create balance between these two groups, by releasing and stretching the tight muscles to bring the upper body back to postural balance or alignment—and then strengthen the weak, inhibited muscles to maintain this balance.
The subacromial bursa is located underneath the acromiom, to prevent compression of soft tissue against the bone. This fluid-filled sac has two major sections and most of it is inaccessible. The more distal portion is the subdeltoid bursa. When the arm is fully abducted, the bursa moves up under the acromiom process. The bursa can be agitated by repetitive compression of the humerus into the acromiom due to a tight upper trapezius, middle deltoid, and supraspinatus muscle. An indicator of bursitis is when shoulder pain begins shortly after initiating shoulder abduction, and continues to about 135˚. This is called a painful arc, which happens because the irritated bursa is compressed as the client abducts the shoulder. After 135˚ of abduction, the irritated tissue moves proximally under the acromiom process and is no longer compressed. The pain is described as being deep within the shoulder joint.
This is a common condition seen in both athletes and non-athletes as these muscles tend to be weak, overstretched, and prone to injury. It is a common early season condition seen in baseball players, especially pitchers. Throwing a ball at 100 mph involves powerful muscles such as the pectoralis major, subscapularis, and deltoid.
Supraspinatus tendonitis is a misleading term, because in many cases by the time the client presents to the therapist he or she no longer has inflammation. A better term would be tendon pain or tendinosis, which is the tearing of tendon fiber sin the absence of an inflammatory process.
Since the rotator cuff involves a group of four muscles, you must perform a thorough assessment to determine which of the muscles are involved: supraspinatus, infraspinatus, teres minor, or subscapularis. It is not uncommon for an athlete to be diagnosed with a rotator cuff injury and actually have bicipital tendinosis.
muscles are involved. The most common muscle to be injured is the supraspinatus , because it is often impinged due to a tight subscapularis, pectoralis minor, upper trapezius, and middle deltoid leading to strained fibers as it moves under the acromiom, as well as the teres minor because it is usually weak and inhibited and placed under extreme eccentric forces during deceleration of the shoulder, especially in athletes.
Thoracic Outlet can include several variations of nerve or vascular compression near the base of the neck and upper rib cage. Compression at the superior thoracic outlet is common and the most understood portion involves compression of the neurovascular bundle passing between the anterior and middle scalenes, also known as Anterior Scalene Syndrome. This part compresses the brachial plexus of nerves and brachial artery. Because the subclavian vein does not pass between the scalene muscles, there are usually only nerve compression symptoms present such as pain, tingling, and numbness in the arms and hands.
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