Humeral Anterior Glide Syndrome 과 목 명 : 임상물리치료진단실습 담당교수 : 유 병 규 교수님 제 출 일 : 2007. 5. 29 발 표 자 : 곽 문 고

Symptoms, Pain problems, associated Diagnosis Anterior or anteriomedial aspect of the shoulder joint Along the proximal one third of the biceps brachii tendon Manual resistance to elbow flexion, shoulder abduction performed with the elbow flexed/ glenohumeral joint laterally rotated Pain increase Glenohumeral medial rotation Shoulder hyperextension, horizontal abduction, flexion (esp. 80~180degree) Symptoms Like bicipital tendinopathy, early stages of impingement syndrome (supraspinatus tendinopathy & bursitis) Anterior dislocation can occur if the anterior joint capsule has been weakened

Movement Pattern Impairments Excessive anterior motion of the humeral head into the anterior joint capsule Glenohumeral abduction Initiation of glenohumeral flexion Return from the end range of flexion (elevation) Glenohumeral joint rotation with the shoulder in 90 degrees of abduction Humeral head의 ant. Movt.시 can palpated

Alignment Impairments More than one third of the humeral head is anterior to the acromial process of the scapula The humeral head is more anterior than the distal humerus The humerus is forward of the acromion in addition to the anterior tilt of the scapula On the posterior surface, there is a slight indentation below the acromion humeral head가 glenoid 에 대해 ant.

Relative Flexibility & Stiffness Impairments The anterior joint capsule is more flexible than the posterior capsule and the glenohumeral lateral rotators

Muscle Impairments Recruitment patterns The action of the pectoralis major muscle as a medial rotator of the glenohumeral joint is more dominant than the action of the subscapuralis muscle The infraspinatus & teres minor muscles are recruited more strongly than the subscapularis muscle when acting as depressors of the humerus

Muscle Impairments Muscle length & strength impairments The lengthened or weak subscapularis muscle the anterior glide of the humeral head Shortness of the scapulohumeral lateral rotators Stiffness of the posterior capsule Preventing posterior glide of the humeral head Shortness of the pectoralis major muscle Medial rotation of the humerus the anterior position of the humeral head Abducted position of the scapula Increased anterior glide of the humerus during shoulder lateral rotation & horizontal abduction Shoulder lateral rotators & medial rotators muscles 알아봄

A. Normal shoulder flexion B. Shortness of posterior joint capsule, so shoulder flexion result in humeral head upwardly

Confirming Test Prevents the anterior glide of the humeral head during shoulder rotation & flexion Decreases the symptoms

Treatment(1) Correct the anterior position of the humeral head at rest Prevent the anterior glide during motion Shorten and strengthen the subscapularis Stiffness or shortness of the humeral lateral rotators must be corrected to enable the humeral head to glide posteriorly Shortness of the pectoralis major muscle should be stretched

Treatment(2) Exercise improves the passive range into Medial rotation (supine) Horizontal adduction (supine; standing against a wall) Flexion (standing facing a wall) Exercise to strengthen the subscapularis Medial rotation (Lying on a table or bed in the prone position) Exercise to humeral head posterior glide Flexion (quadruped position, standing) Assist in reducing the stress on the anterior joint capsule Taping (force to pull the humeral head posteriorly) Correcting scapular alignment Forward or depressed position

Case presentation

Client’s history 34-year-old woman Pain Shoulder abduction (esp. against resistance) Shoulder flexion at the end of the range Has been present for 3weeks At rest (X), awakened by pain at night (X) Ballroom dancing, upper extremity Wt. training Ballroom 무도회

Alignment analysis Slight thoracic kyphosis Rectus abdominis muscles is the primary cause Scapulae are abducted & slightly depressed Both scapulae are positioned more than 3 inches from spine More than one third of the head of the Lt. humerus extends beyond the acromion The proximal end of the humerus is anterior to its distal end Humeral alignment of the Rt. Upper extremity is normal Shortness of the pectoralis minor muscle

Movement analysis During shoulder flexion, the scapula remains depressed & doesn’t adduct at the end range of shoulder flexion During shoulder flexion with elbow flexed, medial rotation of the humerus is observed; with the elbow extends as the shoulder flexion motion is completed (end range pain) Hand up a wall, creating a slight posteroinferior force on the humerus while maintaining lateral rotation (without symptoms) In standing position with elbow flexed, the humeral head can be observed to glide anteriorly when she performs lateral rotation

Muscle length & strength analysis Pectoralis minor muscle shortness Lt. lateral rotators are short During glenohumeral medial rotation, anterior glide of the humeral head is observed Medial rotation of Rt. Humerus is 70 degrees (Lt. side 50 degree) Shortness of the teres major of Lt. side MMT Lt. medial rotators (3+/5) Lt. lower trapezius muscle (4/5)

Pectoralis minor muscle stretch

Diagnosis Humeral anterior glide & scapular abduction syndromes

Treatment Supine exercises Prone exercises Quadruped exercises Instruction: stretch the pectoralis minor muscle Stretch abdominal muscles Performs shoulder medial rotation Prone exercises Quadruped exercises Rock backward toward the heels Standing exercises Facing the wall Back to the wall Maintain lateral rotation as the shoulder flexes with elbow flexed Stretch the rectus abdominis muscle Performs shoulder abduction pain present try to adduct Lt. scapula before abducting from 90 degrees to full elevation relieve pain

Prone exercises

Facing the wall

Outcome 2 weeks 4 weeks Two more sessions 6 weeks Achieve 70 degrees of Lt. arm medial rotation but has to apply strong pressure to the proximal humerus to prevent anterior glide of the head Doesn’t have pain with abduction or flexion as long as she adducts her scapulae before reaching the end of the range of shoulder flexion 4 weeks Shoulder rotation exercises are performed using 2-pound Wts. Lower trapezius exercise in prone Two more sessions Increase her Wts. to 3 and then 4-Pound in each hand Begin using 2-pound Wts. during the motion of elbow & shoulder flexion to elbow extension 6 weeks Pain free with all motions No longer demonstrate anterior glide of the humeral head during shoulder rotation movements

The End! Thank you!