The Four Joints of the Shoulder
The shoulder joint is made up of four joints. 1) Glenohumeral joint (GH), 2) Acromioclavicular (AC), 3) Sternoclavicular (SC), 4) Scapulothroacic.
The process of evaluation of the shoulder joint must include all the joints as individual as well as how they work collectively to make up the “shoulder joint”. Proper assessment should also include the cervical spine to rule out any referred symptoms. The shoulder assessment and location of the lesion is a complex one due to the amount of structures they are involved. The lesion can be inside or outside the joint and depending on the nature of the injury or the clinical findings will determine the exact location.
The shoulder joint is the least stable joint in the body. It requires all of its stability to come from the four major muscles, the rotator cuff muscles. There are many minor muscles as well. The four rotator cuff muscles are; 1) Supraspinatus, 2) Infraspinatus, 3) Teres minor, 4) Subscpularis. Some of the accessory or minor muscles include the pectoral major/minor, serratus anterior, deltoid, trapezium, latissimus dorsi and bicep tendon. There is also the capsular ligament that plays an integral role in the shoulder.
After orthopedic intervention which would include, NSAIDs, Cortisone injection(s) and surgery and symptoms still persist a proper assessment needs to be made. It must include the four joints, the primary and secondary muscles to locate the lingering symptoms and loss of full use.
Treatment would include; Myofascial release, joint mobilizations, and in office rehabilitation. The emphasis in most cases is Myofascial Release, which tends to uncover the root of the problem.
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