A unique quality of being an osteopath is the approach to biomechanics and the shoulder is no exception. The function of the shoulder is to guide the arm through space and hence it requires a considerable range of movement, in fact the shoulder is the joint with the largest range of movement in the body. It achieves the range of movement in a number of ways. The main factor is the incongruity between the head of the humerus and the glenoid fossa which allows the joint a massive range of movement due to its reduced bony apposition. This does however make the joint vulnerable due to lack of support. The shoulder compensates for this with a complex network of muscles and secondary joints and most importantly a tightly bound capsule that keeps the head of the humerus in apposition with the glenoid fossa.
The secondary joints are the acromioclavicular joint, the sternoclavicular joint and the scapulothoracic joint. The acromioclavicular joint keeps the scapula suspended away from the body and allows for changes in the position of the scapula and therefore the axis of movement of the glenohumeral joint. The scapulothoracic joint allows for a large degree of play by sweeping around the thorax and allowing the scapula a large degree of movement. The sternoclavicular joint attaches the scapula to the axial skeleton keep in the shoulder complex firmly attached to the body.
Finally the muscles involved in shoulder function can be divided in to three groups. The suspensory muscles, that is, the muscles from which the scapula and glenohumeral joint are suspended. The suspensory muscles are latisimus dorsi, trapezius, rhomdoid major and minor posteriorly and anteriorly, pectoralis major and minor. The extra-conal muscles or prime-movers of the shoulder joint are middle fibres of trapezius, deltoid, teres major, biceps and triceps whose job it is to move the shoulder in its anatomical directions. The final group is the periarticular muscles, the rotator cuff muscles, supraspinatus, infraspinatus, teres minor and subscapularis.
As osteopaths it is important that our examination and treatment incorporate the role of each of these areas to the patient's shoulder condition. Any alteration due to postural change or trauma can affect the different categories of muscle or joints listed above. As osteopaths it is our duty to view the all the structures and treat them accordingly. The osteopath needs to integrate his knowledge of biomechanics and apply them to the structure of the shoulder and of the body as a whole and treatment should be given accordingly.
For more information on osteopathy and the shoulder:
http://www.osteopath.co.il/sports-injuries-heb.php
http://www.osteopath.co.il/sports-injuries.php
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