Anterior Humeral Glide and Correction

This patient here is a nurse who injured her shoulder resuscitating a baby. She presented with a positive cluster for impingement. The question is what type of impingement. One of the more common ones is subacromial impingement. With a positive Painful Arc Sign, Infraspinatus Test, and Hawkins Kennedy Test, it might have made sense to jump towards that diagnosis. However, the patient had a positive anterior drawers test on the R shoulder and presented with pain with abduction in internal rotation. Check out the video below:

If you watch closely, the first attempt you actually see the humerus gliding anteriorly with abduction as she attempts to abduct (sorry for the poor camera work!). On the second attempt, she focuses on centralizing the humerus while abduction. It may look like she is retracting and depressing her scapula, but the important component is centralization. This is a prime example of why we need to not forget where we come from as movement analysis specialists. If we were to simply rely on special tests, odds are this patient may have been treated inappropriately for a couple weeks. The key is closely watching (and sometimes palpating) the joint during movement - especially the painful/limited movement. The treatment for this patient has been to do self-mobilizations to the posterior capsule in quadruped while rocking back. This also helps to retrain the neuromuscular system for proper scapulohumeral rhythm. Additionally, we have been strengthening the the external rotators from an internally rotated position to help build an anterior restraint. The HEP included IR and ER using a theraband and focusing on centralization of the humeral head.