Dr Satyajit Mohanty blogs

I. Lumbar erector spinae flexion-relaxation phenomenon (FRP): A number of studies have shown differences in the FRP between patients with chronic low back pain and healthy individuals. Presence of the FRP during trunk flexion represents myoelectric silence (1). This leads to increased load sharing on passive structures and further these tissues have been found to fail under excessive loading conditions and are a source of low back pain. Persistent activation of the lumbar erector spinae musculature among patients with back pain may represent the body's attempt to stabilize injured or diseased spinal structures via reflexogenic ligamentomuscular activation thereby protecting them from further injury and avoiding pain (1). However, flexion relaxation phenomenon (FRP) is an interesting model to study the modulation of lumbar stability (2). II. Presence of fatigue of the erector spinae (ES) muscles modifies the FRP Descarreaux et al studied to identify the effect of erector spinae (ES)...

The long thoracic nerve supplies the Serratus anterior, whose root value is (C5-C7) but the root from C7 may be absent. Anatomic path: The roots from C5 and C6 pierce the Scalenus medius, while the C7 root passes in front of the muscle. The nerve descends behind the brachial plexus and the axillary vessels, resting on the outer surface of the Serratus anterior. It extends along the side of the thorax to the lower border of that muscle, supplying filaments to each of its digitations (finger-like projections). Long thoracic nerve injuries in sports: Due to its long, relatively superficial course, it is susceptible to injury either through direct trauma or stretch. Injury has been reported in almost all sports, typically occurring from a blow to the ribs underneath an outstretched arm. Also injuries to the nerve can result from carrying heavy bags over the shoulder for a prolonged time. Symptoms are often minimal – if symptomatic, a posterior shoulder or scapular burning type of pain ma...

Abnormal scapular motion is called scapular dyskinesis. Tennis players with scapular dyskinesia present a smaller subacromial space than non-athletes. Silva RT et al reported in Br J Sports Med (2008 Apr 8) that tennis players with scapular dyskinesia present a smaller subacromial space than control subjects. Additionally, when the shoulder was analyzed dynamically, moving from neutral abduction to 60 degrees of elevation, the tennis players with scapular dyskinesia presented a greater reduction in the subacromial space compared to unaffected athletes. Hence it seems logical that scapular dyskinesis is one causative factor in over-head athletic injuries. However the causal relationship between scapular dyskenesia & shoulder injuries has not been reported. Moreover reliable and valid clinical methods for detecting scapular dyskinesis are lacking. Let us discuss more on this issue on this subject & understand what exactly is scapular dyskenesia & how to test it. Following de...

Classification of FSS (Frozen shoulder syndrome) 1. Primary (Idiopathic) Frozen Shoulder 2. Secondary Frozen Shoulder 1. Systemic 1. Diabetes mellitus 2. hypothyroidism 3. hyperthyroidism 4. Hypoadrenalism 2. Extrinsic 1. Cardiopulomonary disease 2. Cervical Disc 3. CVA 4. humerus fractures 5. Parkinson's 3. Intrinsic 1. RTC Tendinitis 2. RTC Tears 3. Biceps tendinitis 4. Calcific tendinitis 5. AC arthritis *from Coumo, F. Diagnosis, Classification, and Management of the Stiff Shoulder. In: Disorders of the Shoulder: Diagnosis and Management. Iannotti, JP and Williams GR (eds). 1999 Description of pain in primary FSS (Frozen shoulder syndrome): The onset: After a period of pain, localized mostly in the shoulder and / or upper arm, begins the onset of severe limitation of movement of the glenohumeral joint in all directions. Cause: Movement limitation is caused by the retraction of the glenohumeral joint capsule and adhesions...

Current much acclaimed article of Vermeulen HM et al has changed the approach to frozen shoulder. End range mobilization is preferred over other techniques of mobilization. However, administering mobilization in shoulder is not out of danger. Drakos MC et al (The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA) reported “Shoulder dislocation after mobilization procedures for adhesive capsulitis”. This study is published in Orthopedics. 2008 Dec;31(12). No abstract or text available in PUBMED.

1. Antero-posterior and lateral mobilization of the thoracic and lumbar spine (patient seated). 2. Myofascial release of the thoracic spine (patient seated). 3. Atlanto-occiptal release (patient supine; not manipulation). 4. Mobilization of the cervical spine (patient supine). 5. Muscle-energy technique (MET) release of cervical muscles (patient supine). 6. General mobilization of the shoulder joints including use of MET (patient side-lying). 7. Mobilization of the forearms (patient supine). 8. Mobilization of the wrists (patient supine). 9. Mobilization of the SI joint (patient supine). 10. MET to the hip adductors (patient supine). 11. MET to psoas muscles (patient supine). 12. MET to hamstrings (patient supine). 13. Mobilization of the ankles (patient supine). 14. MET to the ankle in dorsi and plantar flexion (patient supine). Note: This sequence has to be performed in this order in 30 minutes.