OMM Review — Upper Extremities
Original OMM review notes for shoulder, elbow, wrist, and hand somatic dysfunction and entrapment neuropathies.
Shoulder Girdle
The shoulder is a complex of glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular motion. Dysfunction often presents as restricted scapulothoracic glide or altered glenohumeral rhythm.
| Motion | Primary muscles / structures |
|---|---|
| Abduction | Deltoid, supraspinatus; scapula upwardly rotates |
| External rotation | Infraspinatus, teres minor |
| Internal rotation | Subscapularis, pectoralis major, latissimus |
| Scapular retraction | Rhomboids, middle trapezius |
Elbow, Wrist, and Hand
Elbow dysfunctions include restricted flexion, extension, pronation, or supination. Wrist restrictions involve the radiocarpal and midcarpal joints. Treat myofascial and articular restrictions while protecting neurovascular structures.
Carpal tunnel syndrome is a median nerve entrapment at the wrist. OMM can address fascial tension in the forearm flexors and improve lymphatic/venous drainage, but advanced or persistent cases may need surgical evaluation.
Common Entrapments
| Nerve | Entrapment site | Key findings |
|---|---|---|
| Median | Carpal tunnel | Thenar weakness, night pain, Tinel/Phalen positive |
| Ulnar | Cubital tunnel / Guyon canal | Interossei weakness, clawing, numbness 4-5 digits |
| Radial | Radial tunnel / spiral groove | Forearm pain, weak wrist extension |
Treatment Pearls
- Balance rotator cuff tone before forcing glenohumeral range.
- Address scalene/pectoralis minor tension for thoracic outlet-type symptoms.
- Use indirect myofascial release and muscle energy before HVLA at the shoulder.
Q: A patient has numbness in the first three digits and weakness of thumb opposition. Which structure is likely entrapped?
A: The median nerve at the carpal tunnel.
Q: Which muscles primarily restrict shoulder external rotation?
A: Subscapularis, pectoralis major, and latissimus dorsi are common internal rotators that can restrict external rotation.