Shoulder Girdle: Maitland's Manipulation & Examination

Maitland's Peripheral Manipulation and the Shoulder Girdle Complex

• Shoulder's protective mechanisms involve postural muscle to relieve the peripheral nervous system of gravity's effects.
• Non-optimal muscle tone can result from postural alignment issues, contributing to peripheral neurogenic pain.
• Cervical spine mobilization improved shoulder lateral rotation in patients with restrictions.
• Mechanisms include neurophysiological effects like referred pain reduction or descending pain modulation.

Subjective Shoulder Examination

• Subjective examinations are similar for peripheral joints, focusing on the glenohumeral joint.
• Ascertain why the patient is seeking treatment, specifically noting any pain, stiffness, instability, weakness, or loss of function..
• Determine if the cause of the issue is from surgery, physical trauma, or a condition.
• Document any recent bruising or swelling.
• Identify if the disorder involves any pain, stiffness, or instability, and note impacted areas.
• Assess the vertebral column and the joints above and below the injury.
• Document symptom behavior, and time-variable factors.
• Find out what provokes or relieves symptoms.
• Investigate any night pain and ability to lie on the affected side.
• Ask about general health, weight loss, and medication or contraindications.
• Conclude by highlighting main findings.

Objective Physical Examination of the Composite Shoulder

• Functional demonstration of movements impacted by the shoulder disorder.
• Differentiate the demonstrated functional movement(s).
• Actively move within limits of pain or resistance.
• Actively note forward, lateral and backward, and cervical movements.
• Perform isometric tests by testing the cuff.
• Palpations for "comparable signs"
• The patient can be prone for hand-behind-back, E, Ad,.
• Isometric tests are done for the cuff
• Look for thoracic outlet and entrapment neuropathy
• Passive movements depend on the pain
• Supine positions for G/H movements

Physical Examination of the Glenohumeral Joint

• Consider the 'accessory joint' between the humerus head and acromion process.
• Observe the patient's willingness to move the arm while undressing
• Active movements depend on the effect on the disorder
• Document abnormalities

Acromiohumeral Joint Examination

• Routine examination includes evaluating the acromioclavicular and glenohumeral joints
• Active movements have to be checked until reaching the pain or the limit

Acromioclavicular Joint Examination

• G/H, A/H and S/Th movements must be examined when there is an issue with the A/C Joint
• Speed of tests and aggravating factors noted
• Palpations will indicate the "injured" movement
• Rotator cuff must be tested for passive movements

Sternoclavicular Joint Examination

• Evaluation should incorportate A/C and relevant G/H, A/H, and S/Th movement when examining the S/C joint
• Thumb pressure is used to asses range and pain

Scapulothoracic Movement Examination

• When examining scapulothoracic disorders also examine the glenohumeral joint
• Note tests and impairing factors
• Test Speed, aggravating factors, injuring movement, movements under load, & Muscle Power
• Passive Movements
  • Note note ROM/Pain.
  • Assess outlet or neurological impailments

Costal and Intercostal Joint Examination

• Trunk movements can test this area
• Test movements and movements that aggravate

Comprehensive Shoulder/ Girdle Exam (Standing)

• Observe alignment, asymmetry, impairment signs, and current pain
• Assess functional movements, stability, and relevant muscles
• Brief elbow appraisal
• Cervical /Thoracic spine should be checked
• Examine in sitting to assess Cervical and thoracic spine and any potential dura issues
• Glenohumeral stability assessed

Key Examination Components(Supine)

• Palpate joint lines and surrounding tissues
• Test glenohumeral stability (anterior, posterior, and inferior)
• Perform physiological shoulder movements, assess quadrant, and observe accessory motions
• Differentiate glenohumeral from acromiohumeral motion.
• Examine acromioclavicular and sternoclavicular joints
• Muscle length performed

Key Examination Components (Prone/side lying)

• Cervical and thoracic palpations
• Scapula Movements
• Initial treatment involves explaining findings and potential treatments, warning about potential symptom increase, and planning subsequent sessions.

Foundational principles of Passive Shoulder Treatment

• The goal will be active movement without any pain
• Passive movements that are limited should be the focus

Standing Alignment Observation

• Body's center of gravity should pass the ear through the shoulder and to the front of the thoracic
• Look for anatomical points like acromion, the line from shoulders, horizontal borders
• Symmetry within the body from both front and back
• If the joints are aligned