ANATOMICAL FUNCTIONAL NOTES ON MANUAL THERAPY OF SHOULDER DISORDERS

Abstract

The shoulder, specifically the shoulder girdle, is the most mobile yet also the most vulnerable functional joint in the adult human body. In clinical practice, there is often uncertainty regarding the specific forms of rehabilitation for a painful and less mobile shoulder. Essential to treatment, in addition to pharmacological and physical therapies, is manual therapy, particularly in a broader myofascial context.

In the pathogenesis of a painful shoulder, secondary causes are undoubtedly more common than clear traumatic injuries. A particularly concerning differential diagnosis is undetected oncology, as well as spinal and peripheral neurovascular origins. However, the most frequent issues are functional disorders caused by prolonged and unilateral functional overloading, coupled with gradually progressive degeneration and eventual fibrosis of the myofascial structures.

From a rehabilitation perspective, limited and painful shoulders are typically addressed symptomatically. The primary goal is to manually restore both passive and active ranges of motion for the entire girdle. In clinical practice, however, outcomes are often inconsistent. The most common reason for this is the late initiation of movement-based rehabilitation, often during the stage when fibrosis has become significantly pronounced. Additionally, a limited understanding of the detailed morphology and its related functional connections contributes to the challenges.

In this text, we summarise selected deeper details of the osseous, connective, and especially muscular (myofascial) morphology, which our (Lewit) school of manual therapy considers valuable for practice.