This text doesn’t deal with accidents to the precise gleno-humeral joint cartilage or ligaments as these are past the scope of therapeutic massage remedy and require medical or surgical intervention. This text offers with the muscle tissues, kinesiology and therapeutic massage therapy of the shoulder/arm muscle tissues.
Let’s begin by itemizing the muscle tissues which encompass the shoulder joint then we’ll outline what makes up the joint itself.
MUSCLES AND ATTACHMENTS:
On the entrance is the pectoralis main which stabilizes the entrance of the shoulder by becoming a member of the sternum with the collar-bone (clavicle) and the arm (humerus).
There are two pectoralis muscle tissues, the second being the minor. It originates from the 3-Fifth rib and attaches on the acromion course of which is the protruding finger which is distinguished on the highest of the shoulder blade (scapula).
The muscle which counters the pectoralis on the again is the rhomboid main and minor. These muscle tissues originate on the spinous or vertebral fringe of the scapula and attaches on the perimeters of the thoracic vertebrae. The minor rhomboid attaches to T1-3 whereas the most important attaches to vertebraes T3-5.They angle downward from inside to outdoors of the physique, medial to lateral. Additionally on the again is the trapezius. It is a massive muscle with three parts: an higher, center, and decrease. The higher attaches to the occiput of the pinnacle and continuing down the neck does a twist on the interior nook of the scapula after which attaches to the skin fringe of the scapula. Its involvement is to raise the scapula shoulder-arm complicated. The center trapezius assists the rhomboids and is extra superficial to the floor. The decrease trapezius attaches throughout the ridge on the scapula (shoulderblade) after which proceeds downward in a diagonal interior course to the spinous technique of the vertebrae and attaches from thoracic 6-12. This a part of the muscle is used to decrease the scapula.
The subsequent most vital muscle tissues that are concerned with the shoulder are the rotator cuff muscle tissues. These encompass the humerus (higher arm bone), are anchored on the scapula and maintain the humerus within the gleno-humeral socket with ligaments helping to offer stability. This joint is loosely-packed to permit probably the most vary of motion, as is obvious with the 360 diploma rotation of the arm.
The anterior rotator cuff muscle orginates beneath the scapula and is known as the sub-scapularis. It attaches to the entrance of the humerus. The highest of the humerus is maintained as an alternative by the supra-spinatus which originates simply above the backbone of the scapula and attaches on the high of the humerus bone. It passes beneath the hook on the acromion course of earlier than attaching there. This presents it some safety.
The Deltoid muscle covers the shoulder joint and supplies the mandatory muscular energy to lift the arm absolutely. It’s made up of three parts, anterior (entrance), center, and again (posterior). All three elements of the deltoid work with different muscle tissues across the shoulder to permit for a circumferential rotation of the arm.
The opposite posterior rotator cuff muscle is just under the backbone of the scapula and is known as the infra-spinatus. It covers the skin (dorsal) decrease a part of the scapula and attaches to the again of the humerus close to the joint capsule.
One other muscle which opposes the rhomboids is the serratus. It attaches to ribs 5-9 on the facet of the physique and attaches beneath the scapula to the vertebral edge. When it contracts it protracts the shoulder blade outward. The alternative motion of retraction is produced by the rhomboids contracting. Generally the serratus can get strained from extreme repetitive motion of protraction,eg: {golfing}, swing a bat, and many others.
Beneath these muscle tissues the gleno-humeral (shoulder)joint is enclosed in a synovial joint capsule and surrounded with ligaments on the again, high, and entrance. Nevertheless the weakest level on the joint is the entrance, and subsequent to ripping the entrance ligaments the arm can dislocate and extra critically protrude anteriorly (in direction of the entrance) with a critically sturdy sufficient affect to the torso or arm. Ouch!
Two different predominant muscle tissues which encompass the shoulder joint are the biceps brachii and the triceps. Each of those muscle tissues are on the back and front respectively of the humerus or arm. The biceps brachii on the entrance has two attachments on the shoulder, one quick, and one lengthy. The quick one attaches on the entrance of the scapula and the lengthy on the highest through an extended tendon. The arm additionally has the brachio-radialis and brachialis that are on both facet of the biceps brachii and which help the arm to flex. Additionally they connect on the entrance of the scapula and supply some energy to the arm-shoulder joint.
On the again of the arm is the lattisimus dorsi which assists to increase the arm backwards. It attaches to the within entrance of the arm close to the shoulder gleno-humeral joint and passes beneath the arm, by way of the arm-pit, and ataches to the ribs on the facet of the scapula, and over the scapula.
The teres minor and main are each arm rotators. The teres minor and teres main each connect on the arm and the outer fringe of the scapula.
The teres main attaches beneath the armpit to the entrance of the humerus subsequent to the latissimus dorsi and it rotates the arm internally when contracting.
The teres minor attaches onto the top-back of the arm and when contracting rotates the arm externally.
So let’s add up all of the muscle tissues which we have listed to this point to see what number of now we have. Pectoralis main, pectoralis minor, rhomboid main, rhomboid minor, trapezius, serratus, sub-scapularis, supra-spinatus, infra-spinatus, biceps brachii, triceps, brachi-radialis, brachialis, latissimus dorsi, teres minor, teres main. That makes sixteen muscle tissues.
KINESIOLOGY- MOVEMENT OF SHOULDER JOINT
The motion of the arm on the shoulder works on many planes and axes. The axes are the x, y,and z.
The ‘X’ axis is the simplest one to study because it strikes the arm from entrance to again, or sagitally (the sagittal aircraft is a entrance to again cross-section dividing the physique left from proper). When the arm is moved from resting on the facet frontwards in direction of the pinnacle is known as flexion. When the arm is moved backwards behind the physique is known as extension. The muscle tissues concerned with flexion are the front-anterior muscle tissues: biceps, brachialis, radio-brachialis. The muscle tissues concerned in extension are the latissimus dorsi and triceps.
The ‘Y’ axis entails the motion of the arm alongside the frontal aircraft( the frontal aircraft cuts the physique entrance to again vertically), from the facet at relaxation into abduction elevating the arm to the highest of the pinnacle. The muscle tissues concerned are the supra-spinatus, deltoid and trapezius. When the arm is taken throughout the chest in horizontal adduction the muscle tissues concerned are the pectoralis main, pectoralis minor, serratus, and anterior deltoid.
The ‘Z; axis entails the motion of the rotation of the arm. With the arm absolutely prolonged and raised to shoulder top the ‘z’ axis goes by way of the physique from left arm to proper arm. When the arm is internally rotated, beginning with palm dealing with entrance and thumbs up rotating arms until thumbs are down and palms again, the muscle tissues concerned on this motion are the teres main and a few latissimus dorsi.
When rotating backwards or exteriorly the muscle tissues concerned is the teres minor.
Rotator cuff stabilizers:
Whereas these muscle tissues talked about above are transferring the arm by way of its vary of motions the rotator cuff muscle tissues are stabilizing the arm by holding it tightly within the gleno-humeral joint. There are three principal rotator cuff muscle tissues: the supraspinatus, on the highest which lifts the arm as properly. The subscapularis, which is beneath the scapula (shoulder-blade), the infra-spinatus which is over the scapula, and teres minor to a lesser diploma due to its attachments presents much less stabilization than the opposite three muscle tissues but could be thought-about an adjunct.
Due to the loosed-pack nature of the shoulder joint that means that as a result of the joint is shallow there may be most flexibility and motion of the joint, as could be skilled by performing a 360 diploma rotation of the arm both in flexion or extension.
Though it isn’t with out some quantity of resistance that this motion is carried out as a result of there are at all times antagonists to agonists, ie: the agonists are the muscle tissues that are contracting whereas the antagonists are the opposing muscle tissues that are stress-free. So it’s fairly a posh feat that after we carry out the arm circumrotation that we don’t expertise some ache or limitations of motion 마사지.
Which is exactly what we expertise when now we have shoulder damage or limitation inflicting ache.
MASSAGE TREATMENTS
I’ve present in my follow as a therapeutic massage therapist in a health centre setting that a lot of the accidents to the shoulder are involving tendonitis, bursitis, and muscle contractures and adhesions.
The 4 varieties of accidents consequence from the repetitious nature of weight coaching or strengthening. There may be positioned an extreme pressure on the tendons, bursas and muscle tissues leading to irritation, tearing, compressing of bursae, and repeated contractures of muscle tissues and ensuing adhesions.
The tendonitis and bursitis can solely be healed by stopping the straining and making use of ice to alleviate the irritation course of. The muscle tissues could be handled for contractures and adhesions with therapeutic massage.
Usually shoppers of the health centre refuse to change or scale back their weight coaching to alleviate the damage and persist to coach by way of the ache magnifying their damage and ache. Those that select to cease their weight coaching lengthy sufficient for the irritation course of to subside and heal have good to finish restoration.
I take advantage of common therapeutic massage strategies to the pectoralis, deltoid, latissimus dorsi, biceps and triceps, and different superficial muscle tissues which encompass the shoulder joint. This then permits me to concentrate to the rotator cuff muscle tissues. What I can do is scale back muscle tone, work out some contractures and adhesions within the deltoids and pectoralis and rotator cuff muscle tissues taking the pressure off the tendons and bursae. Then time does the therapeutic with a a lot decreased weight coaching routine or with full termination of weight coaching till the irritation of tendons and bursae happens, which can take one to 4 weeks relying on the severity of the tendonitis/bursitis.
I discovered that weekly therapeutic massage remedies of one-half hour to one-hour relying on the shopper is sufficient for full therapy of this situation.