On this episode of the #AskMikeReinold present we discuss concerning the shoulder shrug signal and the numerous prospects why this happens. When you study these, you’ll haven’t any drawback determining methods to finest cope with these after they happen. To view extra episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 230: Why Do Folks Have a Shoulder Shrug Signal?
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Present Notes
Transcript
Pupil:
All proper. So Anthony from California asks, “Why after post-op shoulder surgical procedure do my sufferers have points with glenohumeral separation or early scapular upward rotation?”
Mike Reinold:
Oh, I like that Anthony. And I like the way you really put these two issues in there. That was type of attention-grabbing.
Mike Reinold:
So after shoulder surgical procedure, and we are able to most likely discuss this post-op and never post-op too, though post-op tends to vary a little bit bit. However why do individuals have points with glenohumeral separation? So what I’m getting from that’s separation within the humerus from the scapula. Possibly they’re elevating collectively and it certain appears to be like like perhaps there’s some extreme early scapular upward rotation. I like this. It is a good query. And there’s a couple of motive, proper? So who desires to start out? Dave? Would you want to start out this one off?
Dave Tilley:
Solely as a result of I actually had a case yesterday the place it was relevant. Yeah. So I had a younger gymnast who’s doing one thing and he or she basically acquired her arm caught behind her when she was touchdown and hyper prolonged her shoulder and he or she had a reasonably gnarly brachial plexus damage. And he or she’d been by loads of PT and stuff like that. However I believe simply the fundamental delicate tissue flexibility was missed sadly. They have been working loads on her clavicle and her neck was damage, However she had a major quantity of soppy tissue stiffness underneath her arm as a result of her arm was in a sling for awhile as a result of it was propped as much as decompress the world. But in addition she simply hadn’t used her arm in a very very long time and so she had an unlimited quantity of teres main and lapsed manisca that I believe type of went underneath regarded and he or she had nice caps on mobility, tremendous lax, however she simply hadn’t used her arm overhead in a very long time.
Dave Tilley:
In order we all know, the teres main attaches proper to the scap and I believe some analysis reveals that the lat can have a reasonably good attachment as nicely on some individuals. So if you happen to lack primary delicate tissue movement and also you attempt to elevate your arm overhead and you’ll’t get the separation, it’s going to tug the scap alongside for the journey. And that was giving her loads of occlusion ache. So simply primary delicate tissue mobility, I believe is typically simple, however , missed.
Mike Reinold:
I prefer it. Are we going with occlusion ache now? Is {that a} factor?
Dave Tilley:
Is {that a} factor? I simply made it up.
Mike Reinold:
Did we do away with impingement as a result of we are able to’t say impingement anymore? You get-
Dave Tilley:
Nicely it was thoracic compression. She had tingles not ache.
Mike Reinold:
All proper. I’ll offer you that. So now could be there any likelihood she had some nerve stuff going? Was that a part of it?
Dave Tilley:
Yeah, nicely, she undoubtedly did. So we examined that energetic vary of movement. You already know, I used to be fearful about some serratus or neural harm, however passively, she had actually good movement as much as a sure level. So there may simply be a straight up weak point, however she was 9 months out of the damage. So sensitivity was there.
Mike Reinold:
Oh.
Dave Tilley:
She had some allodynia if you happen to’re into that world, however it wasn’t like she had an overt muscle losing.
Mike Reinold:
All proper. In order that’s a good way to distinguish too with the nerve sort factor too. Is that it was very persistent. So it’s not like she had only a fast traction damage of the plexus. I favored that one. And he or she didn’t have some losing atrophy, in order that’s one. So, all proper. In order that’s instance. That’s any individual that’s tremendous free, proper? We’ve got a lax affected person, any individual that has loads of mobility and for some motive she was weak to this. So she simply had some delicate tissue stuff, perhaps some guarding, some self restriction, some mobility considerations only for extended positioning in there. And man, that teres main. Like Dave says the factor will get gnarly, proper. That factor will get actually dense and contracted. It looks like it’s a type of muscular tissues that actually tends to contract in my thoughts.
Dave Tilley:
It was a type of circumstances. However I acquired fortunate the place I labored on it and he or she acquired 10 levels of elevation higher. It’s not going to remain. However she was like, whoa. Proper.
Mike Reinold:
And , it’s arduous to say this, however I believe I’m near feeling this manner, however I really feel like non-operatively, that may be one of many larger causes that I see that is that any individual has delicate tissue restrictions that’s perhaps limiting humeral elevation. In order that manner then the scapula simply goes up as a result of bear in mind your mind and your physique is simply attempting to get your arm over your head. It doesn’t actually care the way it does that. Proper. So if it wants to maneuver the scapula extra as a result of the humerus isn’t transferring. High-quality. Proper. And that’s type of what’s pondering. In order that’s one. We’ve acquired some delicate tissue tightness who desires to throw one into the ring? Leonard?
Lenny Macrina:
I’ll. I’ll. And it type of goes off of Dave, the woman he had lately, as a result of I occurred to get the MRI outcomes emailed. And he or she had additionally a rotator cuff subject. Which matches into what I’ll say is another choice to take a look at, particularly in a post-op shoulder, is the standing of the rotator cuff.
Lenny Macrina:
So this woman who was very younger to not give away an excessive amount of element, she had a rotator cuff, what they’re calling a rotator cuff tear in her shoulder. So if this rotator cuff is just not functioning nicely or if there’s some type of subject to the rotator cuff, you’re not going to have the ability to elevate your shoulder up as simply as if the rotator cuff is hooked up nicely. Proper? So in a post-op shoulder, the rotator cuff is repaired or there’s some type of subject to the cuff it was irreparable. You’re not going to get the conventional arthrokinematics happening within the shoulder. And also you’re going to get that superior migration of the humeral head, which appears to be like like this when any individual tries to boost their shoulder up. So what’s the standing of the rotator cuff in that person who had shoulder surgical procedure? And I’d say, it’s most likely therapeutic, must get robust or it’s not doing nicely. It wants extra work.
Mike Reinold:
Proper. And , oftentimes, you could possibly have a full thickness cuff tear of your superspinatus. In case you’re anterior and your posterior cuff are robust sufficient to stabilize, you possibly can nonetheless by some means elevate that arm and not using a shrug generally.
Lenny Macrina:
Yeah.
Mike Reinold:
However not all the time, proper.
Lenny Macrina:
Proper.
Mike Reinold:
So it could possibly be weak point could possibly be a cuff tear like her. By the way in which, Dave completely unnoticed an enormous piece of that puzzle in your story.
Dave Tilley:
I didn’t wish to steal an excessive amount of thunder.
Mike Reinold:
All proper. Good, good. That’s level. You really had somebody that has each motive.
Dave Tilley:
I didn’t wish to in to the capsular issues.
Lenny Macrina:
That MRI confirmed up on the very finish of the session, I used to be like, hey, by the way in which, you get an MRI proper right here. Oops.
Mike Reinold:
And that adjustments all the pieces going ahead. In order that’s one. So, we acquired some delicate tissue tightness. We’ve got rotator cuff dysfunction and/or tearing. And you may have both of people who may probably restrict that. So once more, perhaps your rotator cuff isn’t stabilizing, you’re both superior migrating or perhaps the humerus isn’t going up and your mind simply says, I acquired to get my arm up. What does it do? It upwardly rotates your scapula extra. It will get it up there extra. I like that.
Mike Reinold:
Who else? I believe Dan had perhaps one other one did or did Lenny steal your thunder?
Dan Pope:
No, I imply, I can discuss this one too. So I assume Dave’s speaking a little bit bit extra about stiffness of the lats and teres main. In fact it could possibly be the capsule as nicely. Proper? So if you happen to don’t have good movement coming from the shoulder joint itself, you’re going to attempt to make up that movement. That’s coming from shoulder blade as an alternative. And the final one, and I believe it’s largely apparent post-op, is ache. Ache’s an enormous one. You already know, if one third of your movement is meant to be coming out of your shoulder blade and two thirds is meant to come back from the shoulder joint and the shoulder joint simply hurts like heck, you’re most likely going to maneuver extra by the shoulder blade. So we predict, okay, the higher entice is just too energetic, however perhaps the higher entice is attempting that can assist you out as a result of your shoulders too weak, too painful, too stiff, no matter motive it’s.
Mike Reinold:
Proper. That’s glorious. That’s really a very good level too, that generally we don’t give sufficient credit score to if it simply hurts to maneuver your humerus. You may even have osteoarthritis of the shoulder joint. Proper. Or you could have one thing happening that causes some discomfort. After which they, once more, simply wish to get their arm up overhead. I like that. After which clearly the capsular stuff. And also you mentioned it fast most likely as a result of in your head it’s fairly apparent, however perhaps not for everyone, is in case you have capsular tightness. An adhesive capsulitis, frozen shoulder sort factor that clearly you’re not going to have the ability to get the conventional movement of the glenohumeral joint and also you’re going to be stiff and your scaps going to go much more.
Mike Reinold:
Now postoperatively what I’d add too, is that if you happen to’re having a stabilization process. So if any individual that has a capsule restore, labral restore or one thing like that, a capsular shift, something the place we’re really engaged on lowering the capsular mobility. So we’re attempting to deal with instability then oftentimes that may be over-tightened proper?. And that may be excessively tightened. After which what occurs is you don’t have the conventional arthrokinematics of the glenohumeral joint.
Mike Reinold:
So to return to the unique query from Anthony, I believe ache’s one which Dan mentioned. I believe rotator cuff dysfunction is an efficient one which Lenny mentioned. After which I’d add simply the particular capsular tightness from the surgical process perhaps limiting it. And bear in mind the mind simply desires to do what’s best. It desires to take the trail of least resistance.
Mike Reinold:
So generally if you happen to’re seeing this, it’s not essentially a foul signal. Typically chances are you’ll simply should do only a few easy issues to simply train them or work on one thing and get them on a little bit little bit of ache. After which impulsively it’ll get a little bit bit higher. They’re simply taking the trail of least resistance. Make sense? So I believe it was good. I believe we nailed it. I believe we coated the overwhelming majority of causes. I imply, there could also be another ones on the market, however I believe these are going to most likely cowl 99% of your those who have a shoulder shrug. So, nice query.
Mike Reinold:
In case you have something like that, profession recommendation, PT, health, power, situation, sports activities, sports activities, something you guys wish to discuss head to mikereinold.com, click on on that podcast hyperlink. And as all the time, please, please, please hold spreading the phrase. Share this with your pals. Share it on Fb and Instagram so we are able to get the phrase out. That might be superior. And we’ll see you on the subsequent episode.
Mike Reinold:
Thanks.
