1. Humeral Anterior Glide Syndrome
과 목 명 : 임상물리치료진단실습
담당교수 : 유 병 규 교수님
제 출 일 :
발 표 자 : 곽 문 고

2. Symptoms, Pain problems, associated Diagnosis
Anterior or anteriomedial aspect of the shoulder joint
Along the proximal one third of the biceps brachii tendon
Manual resistance to elbow flexion, shoulder abduction performed with the elbow flexed/ glenohumeral joint laterally rotated
Pain increase
Glenohumeral medial rotation
Shoulder hyperextension, horizontal abduction, flexion (esp. 80~180degree)
Symptoms
Like bicipital tendinopathy, early stages of impingement syndrome (supraspinatus tendinopathy & bursitis)
Anterior dislocation can occur if the anterior joint capsule has been weakened

3. Movement Pattern Impairments
Excessive anterior motion of the humeral head into the anterior joint capsule
Glenohumeral abduction
Initiation of glenohumeral flexion
Return from the end range of flexion (elevation)
Glenohumeral joint rotation with the shoulder in 90 degrees of abduction
Humeral head의 ant. Movt.시 can palpated

4. Alignment Impairments
More than one third of the humeral head is anterior to the acromial process of the scapula
The humeral head is more anterior than the distal humerus
The humerus is forward of the acromion in addition to the anterior tilt of the scapula
On the posterior surface, there is a slight indentation below the acromion
humeral head가 glenoid 에 대해 ant.

5. Relative Flexibility & Stiffness Impairments
The anterior joint capsule is more flexible than the posterior capsule and the glenohumeral lateral rotators

6. Muscle Impairments Recruitment patterns
The action of the pectoralis major muscle as a medial rotator of the glenohumeral joint is more dominant than the action of the subscapuralis muscle
The infraspinatus & teres minor muscles are recruited more strongly than the subscapularis muscle when acting as depressors of the humerus

7. Muscle Impairments Muscle length & strength impairments
The lengthened or weak subscapularis muscle
the anterior glide of the humeral head
Shortness of the scapulohumeral lateral rotators
Stiffness of the posterior capsule
Preventing posterior glide of the humeral head
Shortness of the pectoralis major muscle
Medial rotation of the humerus
the anterior position of the humeral head
Abducted position of the scapula
Increased anterior glide of the humerus during shoulder lateral rotation & horizontal abduction
Shoulder lateral rotators & medial rotators muscles 알아봄

8. A. Normal shoulder flexion
B. Shortness of posterior joint capsule, so shoulder flexion result in humeral head upwardly

9. Confirming Test
Prevents the anterior glide of the humeral head during shoulder rotation & flexion
Decreases the symptoms

10. Treatment(1) Correct the anterior position of the humeral head at rest
Prevent the anterior glide during motion
Shorten and strengthen the subscapularis
Stiffness or shortness of the humeral lateral rotators must be corrected to enable the humeral head to glide posteriorly
Shortness of the pectoralis major muscle should be stretched

11. Treatment(2) Exercise improves the passive range into
Medial rotation (supine)
Horizontal adduction (supine; standing against a wall)
Flexion (standing facing a wall)
Exercise to strengthen the subscapularis
Medial rotation (Lying on a table or bed in the prone position)
Exercise to humeral head posterior glide
Flexion (quadruped position, standing)
Assist in reducing the stress on the anterior joint capsule
Taping (force to pull the humeral head posteriorly)
Correcting scapular alignment
Forward or depressed position

12. Case presentation

13. Client’s history 34-year-old woman Pain
Shoulder abduction (esp. against resistance)
Shoulder flexion at the end of the range
Has been present for 3weeks
At rest (X), awakened by pain at night (X)
Ballroom dancing, upper extremity Wt. training
Ballroom 무도회

14. Alignment analysis Slight thoracic kyphosis
Rectus abdominis muscles is the primary cause
Scapulae are abducted & slightly depressed
Both scapulae are positioned more than 3 inches from spine
More than one third of the head of the Lt. humerus extends beyond the acromion
The proximal end of the humerus is anterior to its distal end
Humeral alignment of the Rt. Upper extremity is normal
Shortness of the pectoralis minor muscle

15. Movement analysis
During shoulder flexion, the scapula remains depressed & doesn’t adduct at the end range of shoulder flexion
During shoulder flexion with elbow flexed, medial rotation of the humerus is observed; with the elbow extends as the shoulder flexion motion is completed (end range pain)
Hand up a wall, creating a slight posteroinferior force on the humerus while maintaining lateral rotation (without symptoms)
In standing position with elbow flexed, the humeral head can be observed to glide anteriorly when she performs lateral rotation

16. Muscle length & strength analysis
Pectoralis minor muscle shortness
Lt. lateral rotators are short
During glenohumeral medial rotation, anterior glide of the humeral head is observed
Medial rotation of Rt. Humerus is 70 degrees (Lt. side 50 degree)
Shortness of the teres major of Lt. side
MMT
Lt. medial rotators (3+/5)
Lt. lower trapezius muscle (4/5)

17. Pectoralis minor muscle stretch

18. Diagnosis
Humeral anterior glide & scapular abduction syndromes

19. Treatment Supine exercises Prone exercises Quadruped exercises
Instruction: stretch the pectoralis minor muscle
Stretch abdominal muscles
Performs shoulder medial rotation
Prone exercises
Quadruped exercises
Rock backward toward the heels
Standing exercises
Facing the wall
Back to the wall
Maintain lateral rotation as the shoulder flexes with elbow flexed
Stretch the rectus abdominis muscle
Performs shoulder abduction pain present try to adduct Lt. scapula before abducting from 90 degrees to full elevation relieve pain

20. Prone exercises

21. Facing the wall

22. Outcome 2 weeks 4 weeks Two more sessions 6 weeks
Achieve 70 degrees of Lt. arm medial rotation but has to apply strong pressure to the proximal humerus to prevent anterior glide of the head
Doesn’t have pain with abduction or flexion as long as she adducts her scapulae before reaching the end of the range of shoulder flexion
4 weeks
Shoulder rotation exercises are performed using 2-pound Wts.
Lower trapezius exercise in prone
Two more sessions
Increase her Wts. to 3 and then 4-Pound in each hand
Begin using 2-pound Wts. during the motion of elbow & shoulder flexion to elbow extension
6 weeks
Pain free with all motions
No longer demonstrate anterior glide of the humeral head during shoulder rotation movements

23. The End!
Thank you!