Adam Wolf: Shoulder Impingement and Humeral Head Positioning

Adam Wolf demonstrates a simple assessment to observe asymmetries in shoulder mobility and anatomical causes of shoulder impingement.

https://www.youtube.com/watch?v=v6wWsMzxrno

Now let’s go to the spine of the scapula. Everybody know the spine of the scapula?

It separates the supraspinatus from the infraspinatus.

Trace your hand all the way out the spine of the scapula until you get to the very edge of the bone. As soon as you drop in off that edge, that’s the posterior glenohumeral joint.

When I’m looking at the joint, I put my middle finger right on the spine of the scapula. Then I ‘walk’ out with my middle finger to that drop off. That’s the posterior capsule . . . now I know where it is.

My thumb and forefinger will grab the head of the humerus. Just grab it. Here’s the head of his humerus and here’s the back of the joint capsule.

How many fingers are between my forefinger and my middle finger?

We’re roughly two finger-widths here. Again, here’s the head of the bone and here’s the back of the joint.

Let’s look at the other side. Here’s the head of the bone and here’s the back of the joint. You tell me: On which side is the head of the bone forward?

The left is forward more than the right. Can you see that? You can see more of it.

If we look at the back of the joint here (on the left) – here’s the back of the joint and here’s the back of the bone. That’s a big difference, like two fingers-worth.

Versus the right side: less than two fingers-worth. Does that make sense?

So he’s got an anterior sitting head of the humerus on the left side. When we go to some of these positions, like external rotation, I feel the shoulder impingement . . . a pinch in the front because he’s got no place for it to go.

Some of what we need is work on getting the head of his bone to sit back in the joint. That’s some of what the capsular limitation brings; he externally rotates and he feels closing-angle pinch.

Capsule . . . we’ve got to go to it first. That should be cleared up first.

More structure-specific assessments for motion, mobility and stability are in
Adam’s Improving Fascial Highway Systems hands-on lecture video: