Shoulder injuries account for nearly 7.5 million injuries per year in the U.S., with an estimated 250,000 rotator cuff surgeries annually.
Diverse multidisciplinary treatment models include manipulation of the humerus, physiotherapy, ultrasound, electrical stimulation, and laser. Other modalities used range from massage therapy to various fascial and soft tissue approaches, steroid injections, and surgeries.
Some practitioners note that, often, the negative or poor outcomes resulting from shoulder treatment are like “pulling a weed from the top, resulting in regrowth of the weed.”
This is analogous to repeatedly hitting the dashboard of a car, expecting the low-fuel light to go off. Do not do efficiently what does not need to be done.
A common denominator
In fact, there exists a common biomechanical denominator for almost every shoulder condition and injury, excluding fracture, pathology, and infection. The similarity in the root causes of the following conditions is astounding: A-C separation, dislocation, Wright’s hyperabduction syndrome, costoclavicular syndrome, quadrilateral space syndrome, lateral axillary hiatus syndrome, and other entrapment neuropathies—plus rotator cuff impingement and tears.
The American Physical Therapy Association (AMPTA) states that shoulder problems are the result of a short pectoralis muscle length. Accordingly, soft-tissue therapists, chiropractors, and physical therapy treatments focus on the muscle, fascia, and soft tissue. Accordingly, as the cause of the complaint remains disguised and thus neglected, this propagates disgruntled patients with chronic conditions. Often, and to no avail, patients ultimately seek orthopedic consultation resulting in unnecessary steroid injections and unwanted surgical interventions.
During my domestic and international travels for training chiropractic students and DCs, I have had the opportunity to explain and demonstrate my “sniper specific” extremity and spinal adjusting techniques. The anatomical, neurological, and biomechanical explanation of each topic promotes not only understanding among colleagues but also an over- whelming desire to receive a personal treatment as well.
Following a presentation, attendees often rush the stage or booth asking to experience correction of a personal acute or chronic condition. Where all other approaches failed to provide immediate relief or a long- term correction, the results of true biomechanical understanding and correction can ameliorate these conditions and complaints.
Crowds of doctors have observed me with subjects (colleagues, attendees, etc.) who fail the Mazion shoulder maneuver (upward elevation of the elbow with the hand across the chest to the opposite shoulder). Following a signed release with informed consent, I take a brief history, palpate, and check range of motion. The demonstration culminates with a gentle and rapid correction of the most neglected, least understood etiology of shoulder conditions.
After the Mazion test is repeated, the audience applauds as the subject experiences instant relief and significant increase in all planes of shoulder motion and joint function, including spontaneous neurovascular improvement.
The plane truth
The earlier reference to the root cause of most maladies of the shoulder, including recalcitrant cervical and middle-upper thoracic spine issues, is generally “the secret dynamics of the scapula.” Anchoring to the cervical and thoracic spine, it is prudent to recognize that altered scapula plane motion results in compensatory musculoskeletal adaptation.
This often results in confusion on the part of the practitioner, and results in spinal symptomology and complaints distant from their true origin.
According to numerous studies, the scapula is repeatedly referenced as the principle or underlying etiological factor involved in shoulder conditions.1-4
In fact, shoulder problems rarely involve the humerus.
The normal anatomy of the scapula is such that the glenoid fossa is retroverted with respect to most shoulders. Therefore, any alteration of this retro- version is called anteversion, or what I term an “ante-tilted” scapula.
Even a minute change in the angulated glenoid fossa results in complaints of decreased range of motion and similar maladies. This biomechanical change is repeatedly demonstrated during lectures when performing Mazion’s test. When attendees compare pre- and post-movement of the shoulder, and then move the glenoid fossa just amillimeter anterior, it is immediately obvious to the participants that altering the glenoid fossa even the slightest will directly impact shoulder biomechanics and dramatically reduce range of motion.
Aim at the right target
It’s “humorous” that most shoulder problems are not caused by the humerus.
Moreover, the rationale for thinking a short pectoralis muscle length is a cause for shoulder problems is questionable, when it’s actually the result of a protracted and antetilted scapula. In this case, the coracoid process elevates and pulls on the pectoralis minor attachment, resulting in muscular contracture (shortening) due to the stretch reflex mechanism.
This transient neurovascular occlusion beneath the tendon of the pectoralis minor is defined as Wright’s hyperabduction syndrome. The resultant shift of the clavicle medial and inferior contributes to costoclavicular syndrome. Immediately following manipulation of the scapula and clavicle, students and patients typically experience a spontaneous neurovascular change.
This is because an anatomical patency is created beneath the newly relaxed pectoralis minor muscle that had been previously contracted, which opens the costoclavicular space.
Focusing on the soft tissue, stretching the muscle, and myofascial release may prove somewhat helpful. However, if performed in lieu of correcting the scapula biomechanics, most (if not all) shoulder conditions and syndromes will remain a battleground for practitioners and prolong the agony of dysfunction and pain for refractory patients.
By understanding proper joint mechanics and the correction of common problems, you can become the leading extremity expert in your community.
Mitch Mally, DC, has been the owner of a private clinic for 28 years. He is the founder and developer of the International Academy of Advanced Chiropractic Orthopedics. For more information on his techniques, books, and products, visit FromTheDeskOfDrMitchMally.com or contact PJ Cook of Mally Enterprises at pamela_cook@hotmail.com.
References
1 Saha AK. (1961). Theory of Shoulder Mechanism: Descriptive and Applied. Springfield, Ill: Charles C Thomas.2 Kibler WB, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit.’ Br J Sports Med. 2013;47(14):877-85.
3 Moseley JB Jr, et al. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20(2):128-34. 4 Brewer BJ, Wubben RC, Carrera GF. Excessive retroversion of the glenoid cavity. A cause of non-traumatic posterior instability of the shoulder. J Bone Joint Surg Am. 1986;68(5):724-31.
4 Brewer BJ, Wubben RC, Carrera GF. Excessive retroversion of the glenoid cavity. A cause of non-traumatic posterior instability of the shoulder. J Bone Joint Surg Am. 1986;68(5):724-31.
