Assessment and Treatment of the Subscapularis | Dr. Alex Jimenez

These assessment and treatment recommendations represent a synthesis of information derived from personal clinical experience and from the numerous sources which are cited or are based on the work of researchers, clinicians, and therapists who are named (Basmajian 1974, Cailliet 1962, Dvorak & Dvorak 1984, Fryette 1954, Greenman 1989, 1996, Janda 1983, Lewit 1992, 1999, Mennell 1964, Rolf 1977, Williams 1965).

Clinical Application of Neuromuscular Techniques: the Subscapularis Muscle

The subscapularis is a large triangular muscle that fills the subscapular fossa and inserts into the lower tubercle of the humerus and the front of the shoulder joint capsule.

The subscapularis medially rotates the head of the humerus (internal rotation) and adducts it; when the arm is raised, it draws the humerus forward and downward. It is a powerful defense to the front of the shoulder joint, preventing displacement of the head of the humerus.

Damage or trauma from an injury or an aggravated condition can cause shortness in the subscapularis muscle. The following assessments and treatments can help improve structure and function.

Assessment of Shortness in the Subscapularis Muscle

Subscapularis shortness test (a) Direct palpation of the subscapularis is required to define problems since pain patterns in the shoulder, arm, scapula, and chest may derive from subscapularis or from other sources.

The patient is supine, and the practitioner grasps the affected side hand and applies traction while the fingers of the other hand palpate over the edge of the latissimus dorsi to make contact with the ventral surface of the scapula, where the subscapularis can be palpated. There may be a marked reaction from the patient when this is touched, indicating acute sensitivity.

Subscapularis shortness test (b) (as seen in Fig. 4.39 below) The patient is supine with the arm abducted to 90°, the elbow flexed to 90°, and the forearm in external rotation, palm upwards. The whole armrests at the restriction barrier, with gravity as its counterweight.

If the subscapularis is short, the forearm cannot rest easily parallel with the floor but will be somewhat elevated.

 

 

Figure 4.39A, B Assessment and MET self-treatment position for subscapularis. If the upper arm cannot rest parallel to the floor, possible shortness of subscapularis is indicated.

Care is needed to prevent the anterior shoulder from elevating in this position (moving towards the ceiling), giving a false normal picture.

Assessment of Weakness in the Subscapularis Muscle

The patient is prone with humerus abducted to 90° and elbow flexed to 90°. The humerus should be in internal rotation so that the forearm is parallel with the trunk and palm towards the ceiling. The practitioner stabilizes the scapula with one hand and, with the other, applies pressure to the patient’s wrist and forearm as though taking the humerus towards external rotation while the patient resists.

The relative strength is judged, and the method discussed by Norris (1999) should be used to increase strength (isotonic eccentric contraction performed slowly).

MET Treatment of the Subscapularis Muscle

The patient is supine with the arm abducted to 90°, the elbow flexed to 90°, and the forearm in external rotation, palm upwards. The whole arm rests at the restriction barrier, with gravity as its counterweight. (Care is needed to prevent the anterior shoulder from elevating in this position (moving towards the ceiling) and giving a false normal picture.)

The patient raises the forearm slightly, against minimal resistance from the practitioner, for 7–10 seconds and, following relaxation, gravity, or slight assistance from the operator, takes the arm into greater external rotation through the barrier, where it is held for not less than 20 seconds.

 

Additional Topics: Wellness

Overall, health and wellness are essential to maintaining the proper mental and physical balance in the body. From eating balanced nutrition, exercising, and participating in physical activities to sleeping a healthy amount of time regularly, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way toward helping people become healthy.

 

IMPORTANT TOPIC: EXTRA EXTRA: A Healthier You!

OTHER IMPORTANT TOPICS: EXTRA: Sports Injuries? | Vincent Garcia | Patient | El Paso, TX Chiropractor