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Severe aberrant glenohumeral motor patterns in a young female rower: a case report.

Stark TW, Seebauer J, Walker B, McGurk N, Cooley J - Chiropr Osteopat (2007)

Bottom Line: With this type of assessment we found that co-contraction of local muscle groups seemed to initially improve the patients abnormal shoulder motion.Examination also showed associated muscle atrophy of the lower trapezius and surrounding general muscle weakness.It highlights the need for careful examination and thought regarding the anatomical structures and normal motor patterns associated with the manoeuvre being tested.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Science Division, Murdoch University, Murdoch, Western Australia, Australia. t.stark@murdoch.edu.au

ABSTRACT

Background: This case features an 18-year-old female with glenohumeral dysrhythmia and subluxation-relocation patterns. This unusual case highlights the need for careful examination and consideration to the anatomical structures involved.Conventional approaches to shoulder examination include range of motion, orthopaedic tests and manual resistance tests. We also assessed the patient's cognitive ability to coordinate muscle function. With this type of assessment we found that co-contraction of local muscle groups seemed to initially improve the patients abnormal shoulder motion. With this information a rehabilitation method was instituted with a goal to maintain the improvement.

Case presentation: An 18-year-old female with no history of trauma, presented with painless kinesiopathology of the left shoulder (in abduction) consisting of dysrhythmia of the glenohumeral joint and early lateral rotation of the scapula. Examination also showed associated muscle atrophy of the lower trapezius and surrounding general muscle weakness. We used an untested functional assessment method in addition to more conventional methods.Exercise rehabilitation interventions were subsequently prescribed and graduated in accordance with what is known as the General Physical Rehabilitation Pyramid.

Conclusion: This paper presents an unusual case of aberrant shoulder movement. It highlights the need for careful examination and thought regarding the anatomical structures and normal motor patterns associated with the manoeuvre being tested. It also emphasised the use of co-contraction during examination in an attempt to immediately improve a regional dysrythmia if there is suspicion of a regional aberrant motor pattern. Further research may be warranted to test this approach.

No MeSH data available.


Related in: MedlinePlus

see attached jpeg file named "XRay 1".
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Figure 1: see attached jpeg file named "XRay 1".

Mentions: Radiological investigation was ordered to rule out an anatomical aetiology (such as shoulder joint dysplasia) and confirm or deny an aberrant motor pattern as the sole cause of dysfunction. This consisted of plain film radiography and video fluoroscopy. A left shoulder series consisting of AP internal rotation, AP external rotation, and AP weighted (3 kg) neutral views (all taken in Grashey position [20]) revealed no bony dysplasia (Figures 1, 2, 3). Video fluoroscopy consisting of AP and axial projections confirmed the suspicion that the humerus subluxated inferiorly at the glenohumeral joint as it moved through the abduction arc. The axial projection showed a significant posterior component to this subluxation. A follow-up projection AP projection with co-contraction of the shoulder showed that these newly combined motor patterns kept the glenohumeral joint stable, making the arc of motion smoother, and reducing the dynamic subluxation. When viewing the following videos note the significant dysrhythmia for 4 repetitions followed by a smoother rhythm from the patient's conscious facilitation of co-contraction (see Additional file 3).


Severe aberrant glenohumeral motor patterns in a young female rower: a case report.

Stark TW, Seebauer J, Walker B, McGurk N, Cooley J - Chiropr Osteopat (2007)

see attached jpeg file named "XRay 1".
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211480&req=5

Figure 1: see attached jpeg file named "XRay 1".
Mentions: Radiological investigation was ordered to rule out an anatomical aetiology (such as shoulder joint dysplasia) and confirm or deny an aberrant motor pattern as the sole cause of dysfunction. This consisted of plain film radiography and video fluoroscopy. A left shoulder series consisting of AP internal rotation, AP external rotation, and AP weighted (3 kg) neutral views (all taken in Grashey position [20]) revealed no bony dysplasia (Figures 1, 2, 3). Video fluoroscopy consisting of AP and axial projections confirmed the suspicion that the humerus subluxated inferiorly at the glenohumeral joint as it moved through the abduction arc. The axial projection showed a significant posterior component to this subluxation. A follow-up projection AP projection with co-contraction of the shoulder showed that these newly combined motor patterns kept the glenohumeral joint stable, making the arc of motion smoother, and reducing the dynamic subluxation. When viewing the following videos note the significant dysrhythmia for 4 repetitions followed by a smoother rhythm from the patient's conscious facilitation of co-contraction (see Additional file 3).

Bottom Line: With this type of assessment we found that co-contraction of local muscle groups seemed to initially improve the patients abnormal shoulder motion.Examination also showed associated muscle atrophy of the lower trapezius and surrounding general muscle weakness.It highlights the need for careful examination and thought regarding the anatomical structures and normal motor patterns associated with the manoeuvre being tested.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Science Division, Murdoch University, Murdoch, Western Australia, Australia. t.stark@murdoch.edu.au

ABSTRACT

Background: This case features an 18-year-old female with glenohumeral dysrhythmia and subluxation-relocation patterns. This unusual case highlights the need for careful examination and consideration to the anatomical structures involved.Conventional approaches to shoulder examination include range of motion, orthopaedic tests and manual resistance tests. We also assessed the patient's cognitive ability to coordinate muscle function. With this type of assessment we found that co-contraction of local muscle groups seemed to initially improve the patients abnormal shoulder motion. With this information a rehabilitation method was instituted with a goal to maintain the improvement.

Case presentation: An 18-year-old female with no history of trauma, presented with painless kinesiopathology of the left shoulder (in abduction) consisting of dysrhythmia of the glenohumeral joint and early lateral rotation of the scapula. Examination also showed associated muscle atrophy of the lower trapezius and surrounding general muscle weakness. We used an untested functional assessment method in addition to more conventional methods.Exercise rehabilitation interventions were subsequently prescribed and graduated in accordance with what is known as the General Physical Rehabilitation Pyramid.

Conclusion: This paper presents an unusual case of aberrant shoulder movement. It highlights the need for careful examination and thought regarding the anatomical structures and normal motor patterns associated with the manoeuvre being tested. It also emphasised the use of co-contraction during examination in an attempt to immediately improve a regional dysrythmia if there is suspicion of a regional aberrant motor pattern. Further research may be warranted to test this approach.

No MeSH data available.


Related in: MedlinePlus