7 Stages of Spencer Technique: Articulatory Technique of the Shoulder
Spencer Techniques:
- Useful in diagnosis and treating musculoskeletal dysfunction including restriction and pain in the shoulder
- Diagnoses:
- Bursitis
- Tendinitis
- Tenosynovitis
- Fibrous adhesive capsulitis
- Used to evaluate ROMs of shoulder:
- Degree of motion before pain
- Total permitted ROM
Primarily treatment for restricted motion!!
Deltoid (Axillary N. C5-C6)
- Distal attachment is into the deltoid tuberosity of the humerus:
- Clavicular (Anterior) part
- Proximal attachment to the lateral 1/3 of the clavicle
- Action: Flexion and Medial Rotation of the arm
- Acromial (Middle) part
- Proximal attachment to the acromion process of the scapula
- Action: Abduction of the arm
- Spinal (Posterior) part
- Proximal attachment to the spine of the scapula
- Action: Extension and Lateral Rotation of the arm
Big Picture: Shoulder Chief Complaint
Stage 4: Traction Circumduction (Tracking)
Glenohumeral Joint
Latissimus Dorsi (Thoracodorsal N. C6-C8)
I. Appropriate History:
Inflammation
Infection
Trauma
Tumor
II. Apporpriate Physical Examination:
Eliminate any life threatening conditions
ROM
Special tests
Neurological testing
Pulses
- Stabilize shoulder
- Extend arm and Abduct to 90 degrees
- Place slight traction through the arm
- Begin to induce small circles in CW
- Slowly make circles larger
- Start over with small circles in CCW
- Slowly make the circle larger
O: Spinous processes T7-T12, thoracolumbar fascia, sacrum
I: Intertuberular (bicipital) groove
Adducts, extends, medially rotates arm
- Labrum
- fibrocartilagenous structure
- deepens glenoid fossa
- provides increased stability
- Typical ball-socket joint
- Highly mobile
IV. Apporpriate Osteopathic Structural Examination dependent on:
History
Capabilities
Tolerance of positioning
Response to technique
V. Diagnose SD
VI. Apply OMT
VII. Follow Up
Stage 5a: Abduction (Abigail)
- Stabilize shoulder
- Bend arm at elbow and Abduct arm till barrier *
Stage 5b: Flexion, Adduction, External Rotation (FAE)
- Stabilize shoulder
- Have patient place their hand on forearm
- Take elbow toward table to induce adduction w/ ext. rotation until barrier*
Stage 6: Internal Rotation (Inside)
- Stabilize shoulder
- Have patient flex elbow and place dorsum on low back
- Take elbow forward to induce int. rotation*
Stage 1: Extension (Ellie)
- Stabilize shoulder
- Pull arm into shoulder extension till barrier
- *Do this 6-8 times repetitively as ART
- Continuously assess patient's ROM
Stage 2: Flexion (Flew)
- Stabilize shoulder
- Pull or push arm into shoulder flexion till barrier*
Stage 3: Compression Circumduction (Camly)
Stage 7: Glenohumeral Gapping (Glades)
- Place patient's hand physician's shoulder until elbows straighten
- Use finger to contact deltoid muscle and humoral head
- Using scopping motion, lift humoral head away from fossa*
- Can be done before Stage 1
- Stabilize shoulder
- Bend arm at elbow and Abduct shoulder 90 degrees
- Place slight compression on elbow
- Begin to induce small circles in CW
- Slowly make circles larger
- Start over with small circles in CCW
- Slowly make the circle larger