Shoulder Girdle

Diagnosis Subgroup Classification and Motor Control Retraining of the Shoulder Girdle

The majority of shoulder pain starts as uncontrolled movement of the scapula or humeral head which results in mechanisms of abnormal impingement or instability. Identifying what is primary and what is secondary can optimise your management strategies to achieve faster pain management.

Course Outline

Motor control dysfunction within the shoulder girdle contributes significantly to insidious onset, chronicity and recurrence of shoulder pain. Articular or myofascial restrictions to functional movement are common and part of everyday life. The body normally maintains function by subtly increasing motion elsewhere to compensate for many of these restrictions. If these compensations are effectively controlled, then the body adapts well and stays symptom free. However, if there is inefficient control of compensatory motion, Uncontrolled Movement (UCM) and stability dysfunction develops, eventually resulting in symptomatic motion of mechanical origin. The efficient control of scapular orientation and the subsequent ability to control gleno-humeral range and translation is essential for managing impingement and instability dysfunctions of the shoulder girdle.

This course reviews the functional anatomy of the shoulder girdle. It includes a review of impingement and instability mechanisms and details the assessment of local and global motor control dysfunction around the scapulo-thoracic and gleno-humeral joints. The diagnosis of mechanical shoulder dysfunctions is based on identifying the site and direction of uncontrolled movement (UCM). Using a clinical reasoning framework, the development of specific ‘prescriptive’ individual retraining programmes to regain functional stability of the shoulder girdle is presented. This course is orientated to a ‘hands on’ practical application of dysfunction assessment and stability retraining using patient examples where possible.

Key Features

This course addresses:

• what goes wrong with the control of scapular and humeral movement when people have pain
• how to test for uncontrolled flexion, abduction, extension, rotation and translation of the shoulder girdle
• how prioritize the where to start therapeutic exercise and how to develop progressions

This course will help you to:

• re-evaluate muscle function around the scapula and humeral head
• identify direction - related uncontrolled movement related to symptoms
• diagnose impingement and instability mechanisms of the shoulder and assess for related uncontrolled movement
• identify and retrain motor control dysfunction in the local muscle system of or the scapula and the humeral head
• identify and retrain abnormal strategies and patterns within the global muscle system
• design specific individual retraining programmes

Learning Outcomes

At the end of this course the participant should be able to:

• Discuss basic motor recruitment processes
• Classify muscles around the shoulder girdle based on function & dysfunction
• Explain the development of movement and stability dysfunction
• Discuss the differences between high threshold traditional muscle strengthening, ‘core’ stability training of proximal muscles & stability related low threshold motor control within the movement system
• Define and analyse the concept of stability dysfunction uncontrolled movement (UCM) and how it develops within the movement system
• Analyze the inter-relationship between UCM & restriction in articular and myofascial tissues in relation to the shoulder girdle
• Clinically assess shoulder motor control strategies to identify and diagnose the presence of uncontrolled movement
• Relate UCM to impingements and instabilities
• Rate the degree of severity of stability dysfunction and discuss prognosis

The participant should demonstrate the ability to apply principles of assessment and motor control retraining to:

• Develop an evidence based management plan to improve functional control
• Use clinical reasoning to prioritize initial management and plan a progression of rehab
• Apply rehabilitation strategies to manage stability dysfunction
• Use re-assessment tools to guide the rate of progression of an individual patient through their rehab programme

Programme Outline

Shoulder Girdle Dynamic Stability

Shoulder Girdle Functional Anatomy

• Dynamic stability of the scapula
• Role of the scapula
• Motion of the scapula
• Anatomy review of the scapula stability and mobility muscles
• Passive stability mechanisms of the gleno humeral joint
• Anatomy review of the active stability mechanisms of the gleno humeral joint – stabiliser and mobiliser muscles

Alignment Assessment

• Palpation of landmarks
• Assessment of shoulder girdle posture and alignment
• Clinical guidelines for ideal

Kinaesthetic Repositioning

• Proprioception and pain
• Proprioception and recruitment