http://physicaltherapy.rehabedge.com...le.aspx?m=1314
Due to prolonged forward shoulder or protracted scapular position, an individual who works posteriorly to the "new" scapular plane, can create anterior shoulder laxity. The repetitive stress to the structures of the anterior shoulder (biceps tendon, pec major, etc) can create inflammation in these tissues each time the humeral head is brought back behind the body or "new" scapular plane. You can assess this by looking at the scapular position in normal resting posture (patients tend to sit up straight when they are being evaluated...remind them to sit normally and comfortably...)
look at the distance of the medial scapular border form the spine (greater than 2-3 inches and they are protracted). Grab the acromion (from front to back, in a pinch like grip) do the same with the humeral head. Compare the position of the acromial arch to the humeral head position.
If you see the humeral head anterior to the acromion, they have a forward position.
If you find this stop any rehab activity or exercise you are doing that makes them extend the humerous beyond the limit of scapular movement (preventing anterior humeral glide and further stress).
This includes any pec stretchs (especially corner or doorway positions) and row like activities. The patient's movement must be re-educated to include movement of both the humerous and scapula in unison, when moving backward into the scapular plane. Anchoring structures to the scapula should be addressed, most especially pec minor, while protecting the humeral head position. Stabilizing structures to the scapula need to be strengthened...again in such a way as the patient does not move the humerous without the scapula, and maintains a good scapular planal movement. Low traps especially.
If there is medial border winging then serratus as well.
Thoracic posture can also be addressed, although I believe you need to address whole spinal posture to make changes...increased thoracic kyphosis can increase scapular protraction.
MOdalities can be used to calm down the anterior shoulder structures, but I might us iontophoresis with dexamethosone instead of IFC. Ice massage is great post too.
Mobilize the joint cautiously keeping in mind you already have anterior joint laxity...you do not want to create a multidimensional laxity. But check out the inferior and posterior joint capsule and posterior musclature for tightness...actively, they might be pushing the humeral head forward with stabilizing contractions...even external rotation exercises done without awareness can push it anteriorly...
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i used to ahve bicep tendonitis so this is pretty spot on for me
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