By: Mark N. Charrette, DC
(See all of the figures at the bottom)
The following is a checklist/protocol that I follow to adjust the typical shoulder (Fig. 1). Depending on what research you read and what your definition of “joint” is, the Chiropractor will come up with a differing number of shoulder joints.
I adjust four shoulder joints/articulations: the glenohumeral joint; the acromioclavicular joint; the sternoclavicular joint; and the costoscapular articulation. This will demonstrate how I adjust, stabilize, and rehabilitate the typical shoulder.
The Glenohumeral Joint
This joint will subluxate in an anterior direction the vast majority of the time. The muscle test pictured in Figure 2 is a valuable tool in determining the integrity of the glenohumeral joint. With patient supine, patient’s arm straight and thumb superior, the doctor instructs patient to “pull.” The indicator for an adjustment is a grade 4 response which is an eccentric/isokinetic contraction.
Adjustment. With patient supine, doctor’s “inside” hand thumbweb contact the pectoral-deltoid groove (Fig. 3). “Outside” hand abducts arm. Thrust is via “inside” thumbweb in an anterior-to-posterior direction. Postcheck adjustment using same muscle test.
The Acromioclavicular Joint
The most common direction of subluxation for this joint is the distal clavicle subluxates superior. This may produce a “horizon sign” (Fig. 4). It is likely that the horizon sign will persist even after an adjustment.
Adjustment. Doctor is seated next to patient with patient’s arm resting on doctor’s shoulder. Doctor overlaps Chiropractic index fingers over distal clavicle (Fig. 5). Thrust is in a superior-to-inferior direction.
The Sternoclavicular Joint
The doctor will find palpable anteriority of the proximal clavicle, along with point tenderness and possible swelling. Direction of subluxation is usually anterior with the possibility of an inferior or superior component.
Adjustment. The patient will be sitting, with the doctor standing behind the patient. Doctor’s “outside” arm and hand gently pull lateral and posterior as the fleshy pisiform of “inside” hand contacts medial aspect of proximal clavicle and gently pushes lateral and posterior (Fig. 6). This adjustment should be considered a push/pull adjustment and not a dynamic thrust.
The Costoscapular Articulation
Since this articulation lacks a joint capsule, many do not consider this a true joint. In any event, this articulation can be a very symptom-producing joint.
Adjustment. Doctor’s back hand contacts scapula with little finger medial to the medial border of scapula and heel of hand contacting inferior angle of scapula (Fig. 7). “Front” hand contacts anterior aspect of shoulder.
“Back” hand moves inferior angle of scapula superior and lateral as “front” hand pushes anterior to posterior. Crepitus and audible releases are common. Four to five repetitions are recommended. Doctor should be sure to keep “elbows out” and compress shoulder first before inducing motion.
Humeral Head Inferior Glide
In some cases, shoulder symptoms are produced by a fixation/subluxation of the humeral head in a superior direction.
Adjustment. Doctor stands behind patient contacting humeral head with thumb tip (Fig. 8). Pressure is applied inferior and slightly medial. Motion should be detected in the non-fixated patient. If no motion is detected, doctor applies pressure inferior and medial several times to induce motion.
Levator Scapulae Tendon
It appears to me that the levator scapulae tendon can torque or roll in an inferior and medial direction, potentially producing pain, swelling, and restricted rotation of the upper thoracic and lower cervical spine.
Adjustment. Doctor stands on side opposite of involved shoulder (Fig. 9). “Front” hand contacts deltoid and elevates to cause laxity of levator scapulae tendon. Thumb tip of “back” hand contacts inferior/medical aspect of tendon and pushes (keeping contact with skin) on a superior and lateral direction. Increase in lower cervical/upper thoracic rotation is usually noted.
It appears to me that the weight of the arm and hand can be enough stress on the shoulder to re-subluxate it shortly after an adjustment. Using two pieces of 3” Elastikon, shoulder stability is increased dramatically. As shown in Figure 10, pull in direction of arrow. Pull tape as tightly as possible. Leave on 24 hours.
Rehabilitative exercise should not be overlooked. Here are two shoulder exercises that I find very valuable.
Scapular Squeeze. Patient holds arms laterally at 90˚, then “squeezes” to approximate the medial borders of the scapula (Fig. 11). Uses rhomboids major and minor. Dorsal scapular nerve, C5 nerve root.
External Shoulder Rotations. Performed with Foot Levelers’ THERA-CISER® Therapeutic Exercise System. Patient may utilize either a bent-arm (Fig. 12) or straight-arm approach. Uses teres minor and infraspinatous muscles. Long thoracic nerve, C5-6.
One final recommendation: Patients with shoulder problems should always be evaluated for pedal instability. If such an instability is confirmed, Foot Levelers’ custom-made, flexible orthotics can help restore structural balance by supporting the foot and ankle joint in a more near-normal position, thereby affecting the entire biokinetic chain, including the neck and shoulder areas.
- Cailliet R. Shoulder Pain. Philadelphia: F.A. Davis Co., 1981.
- Christensen KD. Clinical Chiropractic Biomechanics. Dubuque, IA: 1984.
- Christensen KD. Clinical Chiropractic Orthopedics. Dubuque, IA: 1984.
- Hoppenfeld S. Physical Examination of the Spine and Extremities. Norwalk, CT:
- Appleton-Century-Crofts, 1976.
- Kapandji IA. The Physiology of the Joints (5th ed.). New York: Churchill Livingstone, 1989.
- Pick TP and Howden R (eds.). Gray’s Anatomy (rev. Am. ed.). New York: Bounty Books, 1977.
About the Author
Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic in Davenport, IA and a former NCAA All-American swimmer. He has taught hundreds of seminars in the United States and internationally on Chiropractic adjustive procedures and biomechanics.