Shoulder Clunking - what's the cause?

[Physio33]

Thanks a million to everyone who replied to the Shoulder Clunking Problem.

The pt. I had was incidently my brother, so he only let me assess/treat him on and off over the past few weeks. He didn’t allow me to fully assess his as he wanted a quick fix treatment exercise program! So I apologise for my lack of objective findings from my physical exam. Any future patients will not be family members I assure you all.

His progress to date has been pretty good.
The main agg. factor for his clunking shoulder was
- doing high reps of lat pull downs in the gym ie 10 in a row.
- Shoulder clunked when he started to fatigue, so was clunk free at rep 6-7.

Currently his mgmt to date has included
- Scapular setting exercises (He had a Winging Scap)
- Internal rototor strengthening exercises
- Reduction of reps of pull downs
-Some thoracic joint Grade 3 mobs for the stiffness there.


I’m a fairly new member to this forum and am well impressed with it.
Look forward to being in touch with ye all again. It's great bouncing ideas off each other. This Forum is blessed having regular input from many physiotherapists with years of clinical experience behind them in this field.

Thanks for all the discussion and brainstorming about the Clunking Shoulder.
A topic not touched on at college these days!
Physio33

[linbin]

hi guys
i would like to add something more.as everybody knows shoulder,especially the glenohumeral joint depends on muscles more for stability.during movements,dynamic stability is mainly provided by rotator cuff muscles.concavity compression action my rotator cuff,help to maintain the integrity of the joint .so that other superficial muscles can act.when rotator cull is functioning properly it reduces translation to a minimum,bcos of its force couple action with deltoid in the vertical direction and force couple between subscapularis anteriorly and infraspinatus and teres minor posteriorly in transverse direction.so rotator malfunctioning leads to abnormal translation -clunking-ligament,capsular stress and lesions.so our management should give primary importance to causes of rotator malfunctioning and strengthening of rotator cuff muscles.

[bikelet]

"His progress to date has been pretty good.
The main agg. factor for his clunking shoulder was
- doing high reps of lat pull downs in the gym ie 10 in a row.
- Shoulder clunked when he started to fatigue, so was clunk free at rep 6-7.

Currently his mgmt to date has included
- Scapular setting exercises (He had a Winging Scap)
- Internal rototor strengthening exercises
- Reduction of reps of pull downs"

Hi, sorry to come in late on this thread. My suggestion is external rotators. Generally, these tend to be weaker than internal rotators so if he needs to be strengthening anything it should be this. I read an article in a gym magazine (sorry don't know the ref) about training for doing chin ups. The trainer said that building up external rotator strength is critical to the successful performance (and good form) of this skill. Trying looking up articles about this on the net.

Also has he tried setting his scapula prior to pulling down on the lat pull downs? It's easy to get lazy and not move properly, especially when fatigued. Teaching general body awareness may help. Also look at hand position on the lat pull down bar and in pull ups- a wide grip generally stresses the shoulder more