Difficulty and restriction when reaching into your back pocket or when putting on a shirt are examples of restriction in internal rotation of the shoulder joint. Internal rotation involves the movement of placing your lower arm behind your lower spine.
Injuries of the shoulder that can restrict shoulder joint internal rotation movement include Acromion bursitis, AC joint sprain, strain to the subscapularis muscle and rotator cuff tendonitis. However if there is no known trauma to the shoulder, the movement restriction can be caused by abnormal tightening of the joint capsule of the shoulder joint. This is a restriction that I see on a regular basis in my clinic.
What is Shoulder Capsule Restriction?
The shoulder capsule is a sleeve of tissue that surrounds the rim of the glenoid fossa (shoulder socket) and attaches to the head of the humerus (bone of the upper arm). Along with the ligaments of the shoulder its role is to reinforce the shoulder joint, hence assisting in stabilising the joint. However, this shoulder capsule can become abnormally tight and thus restrict shoulder rotational movement. If the Posterior Joint Capsule at the back of the shoulder becomes tight then it restricts the movement of placing the hand behind the lower spine. The patient then finds a big difference in movement when comparing movement to the opposite shoulder. A history of carrying bags, previous shoulder surgery and rounded posture posture can lead to shoulder joint capsule restriction.
Who does this affect?
Patients who have never injured the shoulder but have carried heavy bags or buckets over a long duration causing a downward pulling traction of the shoulder joint.
People who play or previously played overhead sports such as tennis, basketball, GAA
Patients who have shoulder surgery for labral tears
Tradesmen who work overhead and also people with rounded shoulders.
Management and treatment
Tightness of the shoulder capsule can be treated by graded mobilisations that encourage gradual stretching of the posterior joint capsule. Mobilisation to encourage movement into the shoulder blade coupled with stretching soft tissue manipulation of the muscles that pull the shoulder blade upwards and forwards such as upper trapezius and pectoralis minor muscle should be included. Retraining of the weak shoulder blade muscles alongside emphasising good upper body posture is very important in the treatment plan.
Tomás Ryan is a registered physical therapist (MIAPT) with The Irish Association of Physical Therapy and is based in Clonmel & Thurles.
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