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Expert Biomechanical Assessment of Shoulder In Delhi NCR.

Biomechanical assessment of shoulder
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What is Biomechanical Assessment of Shoulder?

A biomechanical assessment of the shoulder is a comprehensive evaluation of how the complex structures of the shoulder joint interact during movement, aiming to identify impairments that contribute to pain or dysfunction. It goes beyond simply identifying the source of pain and delves into the underlying mechanical factors.

What is Shoulder Complex?

The shoulder is often considered one of the most complex joints in the body. It’s not just one joint, but a “complex” of four articulations working in concert:

  • Glenohumeral (GH) joint: The true ball-and-socket joint between the humerus (arm bone) and the glenoid fossa of the scapula (shoulder blade). It offers vast mobility but sacrifices stability.
  • Acromioclavicular (AC) joint: Between the acromion (part of the scapula) and the clavicle (collarbone).
  • Sternoclavicular (SC) joint: Between the sternum (breastbone) and the clavicle.
  • Scapulothoracic (ST) joint: Not a true anatomical joint, but a functional articulation between the scapula and the rib cage. Its movement is crucial for overall shoulder function.
Biomechanical Principles Assessed
  • Scapulohumeral Rhythm: This refers to the coordinated movement between the glenohumeral joint and the scapulothoracic joint during arm elevation. Normally, for every 2 degrees of glenohumeral movement, there’s approximately 1 degree of scapular upward rotation. Disruptions in this rhythm (e.g., dyskinesis, or abnormal scapular movement) can lead to impingement, instability, and pain. Physiotherapists observe for smooth, coordinated motion and identify any “hitching,” “winging,” or “tipping” of the scapula.
  • Dynamic Stability: The shoulder relies heavily on dynamic stabilizers—the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and scapular stabilizing muscles (e.g., serratus anterior, trapezius). These muscles work to keep the humeral head centered within the shallow glenoid fossa during movement. A biomechanical assessment looks for:
  • Strength and Endurance: Weakness or fatigue in these muscles can lead to abnormal humeral head translation and impingement.
  • Motor Control: The ability of muscles to activate at the right time and with the right intensity. Poor motor control can result in compensatory movements.
  • Passive Stability: This refers to the role of non-contractile structures like ligaments (e.g., glenohumeral ligaments, coracohumeral ligament), joint capsule, and the labrum (a fibrocartilaginous rim around the glenoid). Excessive laxity (hypermobility) or tightness (hypomobility) in these structures can impact joint mechanics.
  • Muscle Length and Flexibility: Tightness in certain muscles (e.g., pectoralis minor, posterior capsule) can alter scapular position and restrict normal range of motion, contributing to impingement or pain.
  • Posture: Overall posture, especially of the thoracic spine and neck, can significantly influence shoulder mechanics. Forward head posture or rounded shoulders can alter scapular resting position and increase the likelihood of impingement.
Components of Physiotherapy in Biomechanical Assessment of Shoulder

  • Subjective History: Questioning about the patient’s pain, mechanism of injury, aggravating/relieving factors, activities of daily living, and any previous treatments. This helps to form initial hypotheses about the underlying biomechanical issues.

  • Observation: Observing the patient’s static posture, scapular position at rest, and dynamic movements (e.g., reaching, lifting, overhead activities) for any asymmetries, muscle wasting, or abnormal movement patterns (scapular dyskinesis).

  • Palpation: Feeling for tenderness, muscle tone, swelling, or bony abnormalities around the shoulder complex.

  • Range of Motion (ROM) Assessment:

    • Active ROM: Assesses the patient’s voluntary movement in all planes (flexion, abduction, rotation, extension) and observes pain, compensatory movements, and scapulohumeral rhythm.

    • Passive ROM: Assesses the end-feel and any limitations caused by joint stiffness or muscle tightness, differentiating between physiological and accessory movements (arthrokinematics).

  • Strength Testing: Manual muscle testing of key shoulder and scapular muscles (rotator cuff, deltoid, biceps, triceps, serratus anterior, trapezius).
  • Special Tests: A battery of specific tests designed to provoke symptoms and help identify the integrity of specific structures (e.g., rotator cuff tears, labral tears, instability, impingement).
  • Neural Assessment: Assessing the cervical spine and peripheral nerves as referred pain or nerve impingement can mimic shoulder pain.
  • Functional Assessment: Observing how the patient performs daily tasks or sport-specific movements to understand how biomechanical impairments impact their function.
Purpose of the Biomechanical Assessment of Shoulder

The goal is to identify the root cause of the shoulder problem, not just the symptoms. By understanding the faulty movement patterns, muscle imbalances, or structural limitations, the physiotherapist can develop a targeted and effective treatment plan. This might involve:

  • Exercises to improve muscle strength, endurance, and motor control.
  • Manual therapy to address joint stiffness or soft tissue restrictions.
  • Postural re-education.
  • Activity modification and ergonomic advice.
  • Education on proper movement mechanics.

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