chiropractic treatment options for shoulder conditions · •abduct arm to 90°, angle forward 30°...

Chiropractic Treatment Options for Shoulder

ConditionsWendy Varish, DC, FACO, CCSP, CCOHC, MCS-P

Proudly Sponsored by:

Wendy Varish, DC, FACO, CCSP, CCOHC, MCS-P

Howards Grove Chiropractic

516 S. Wisconsin Drive

Howards Grove, WI 53083

(920) 565-3922

fax (920) 565-2142

[email protected]

Syllabus-Chiropractic Treatment Options for Common Shoulder Conditions

You have a busy office.

You have learned great techniques for treatments at other seminars, but the time it

takes to implement these techniques is just not practical.

From rotator cuff conditions to frozen shoulder, this 4 hour program will provide the

doctor with comprehensive treatment options that can be realistically applied within a

busy office. Advanced therapeutic applications and adjusting techniques will be

highlighted.

2 MINUTE ABC’S EVALUATION

aka… The “Hey Doc, could you please just ‘quick’

check out my shoulder?” Exam

2 Minute ABC’S Evaluation

■ Adhesive Capsulitis vs. Scapular Fixation

■ Bicep Tendon Subluxation

■ Clavicle Fixation

■ SITS/ Supraspinatus or Rotator Cuff Tear

How Many “Joints” in a Shoulder?

■ Glenohumeral

■ Acromioclavicular

■ Sternoclavicular

■ Scapulothoracic

AAdhesive Capsulitis vs.

Scapular Fixation

A: Adhesive Capsulitis vs. Scapular Fixation

■ Patient is unable to perform true

abduction of the arm

■ Evaluate for scapular motion vs. true

adhesions at the GH joint

A: Adhesive Capsulitis vs. Scapular Fixation■ Evaluate for scapular

motion vs. true adhesion of

GH joint/capsule


■ Before adjusting shoulder, evaluate for upper cervical spine subluxation and

suboccipital involvement

■ Correct spinal subluxation to free CN XI

■ Re-assess shoulder abduction and scapular motion

■ Address trapezius and subscapular muscle adhesions

■ Re-assess

■ Adjunct Therapeutic Options

– Laser/Light Therapy

– Ultrasound

BBicep Tendon Subluxation

B: Bicep Tendon Subluxation

■ Patient presents with “decent” range of

motion, but “achiness” and “heavy” pain in

joint

■ May describe weakness with certain

activities/movements


■ Test: Patient seated with arm abducted to 90*. Test

resistance in internal (thumb down) and external

rotation (thumb up)

– Can test opposite side for comparison

■ Tenderness with palpation may be elicited at the

transverse ligament/bicipital groove

■ NOTE: 90*Abduction and ER isometric test ->

palpate biceps tendon in bicipital groove if pain

anterior it's a tendon problem, if the pain is posterior

then it is likely to be internal impingement


■ Correction: Contact bicep tendon with lateral index contact. Pull tendon superiorly

and laterally until feel “jump” into bicipital groove

■ Retest – immediate improvement in strength should be achieved

■ Cervical involvement – adjust as needed



– IFC/Pre-mod

CClavicle Fixation

C: Clavicle Fixation


■ Patient presents with pain at anterior

shoulder/ chest/ pect

■ General /active ROM may be somewhat

restricted

■ May describe weakness with certain

activities/movements


■ Test: Patient supine. Support patient’s arm and abduct to 90* with elbow bent to

90*. Test passive internal and external rotation

– Determine if clavicle is fixated in external or internal rotation (or both)

■ Consider muscular involvement – address cervical spine subluxations


■ Correction:

– Make correction by adjusting clavicle with rotational impulse into direction of

fixation

– Address cervical subluxations related to muscular attachments

■ Retest


– Laser/Light Therapy -- to cervical spine, trapezius

– ? Ultrasound or IFC to muscles creating chronic subluxation/fixation

SSITS/Rotator Cuff/

Supraspinatus Tear

■ More involved than just

“primary” tear

■ May present with pain, loss of

ROM, loss of strength,

interference with ADL’s

■ Pain may encompass and

include pathology at other

muscles

– Deltoid(s)

– Biceps

– Subscapularis

S: SITS/Rotator Cuff/Supraspinatus Tear


■ Tests:

– Supraspinatus Press Test

– Abduction ROM with “painful arc”

– Drop Arm

• Supraspinatus Strength / Supraspinatus Press Test• strength is assessed using Jobe’s Test (see below) – pain with this test is indicative of a

subacromial bursitis/irritation – not necessarily a supraspinatus tear. Only considered positive for

tear with a true drop arm. i.e. arm is brought to 90° and literally falls down.

• Jobe’s Test (“Empty Can Test”)tests for supraspinatus weakness and/or impingement

• technique

• abduct arm to 90°, angle forward 30° (bringing it into the scapular plane), and internally

rotate (thumb pointing to floor). Then press down on arm while patient attempts to maintain

position testing for weakness or pain.

• Drop Signtests for function/integrity of supraspinatus

• technique

• passively elevate arm in scapular plan to 90°. Then ask the patient to slowly lower the arm.

The test is positive when weakness or pain causes them to drop the arm to their side.


■ With “2 Minute” Evaluation - will need to address cervical spine as well as all four

“joints” in order to provide best conditions for healing

■ Therapeutic Modalities:

– Laser/ Light Therapy

■ Progress through Rehab Exercises

– Passive ROM

– Assisted ROM

– Active ROM


■ Passive ROM

– Codman’s

– Pulley

– Broomstick/cane

■ Assisted ROM

– Broomstick/cane

– Wall-Walking

■ Active ROM

– Disco / Apple Picking


Rehab Exercises


Case Studies

30 Second Evaluation?

■ Therapeutic Options


– Rehab Exercises

BEYOND THE 2 MINUTE ABC’S

Shoulder Examination / Evaluation

TUNE IN NEXT TIME!

Wendy Varish, DC, FACO, CCSP, CCOHC, MCS-P

Howards Grove Chiropractic

516 S. Wisconsin Drive

Howards Grove, WI 53083

(920) 565-3922

fax (920) 565-2142

[email protected]

chiropractic treatment options for shoulder conditions · •abduct arm to 90°, angle forward 30°...

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