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

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.

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.

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

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.

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

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.

“Scapulothoracic Joint”

• Scapulothoracic – Between the anterior

surface of the scapula and the ribs, with muscle and fascia between the bony surfaces.

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.

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

Anterior Shoulder CS Points

Posterior Shoulder TP

Spencer’s Technique • Extension • Flexion • Circumduction • Circumduction with

traction • Abduction

(adduction) • Internal rotation • Traction

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

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

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

Median Nerve C6-C8

• Fine control of the pincer grip

• Extrinsic flexors of the hand

• Intrinsic thenar muscles

Carpal Spread