Shoulder pathologies have been reported as the third most popular musculoskeletal problem
after knee and back problems and are relatively common in 1 in 3 individuals in their
lifetime and reported shoulder pain once a year. The Popular shoulder complex disorders are
tendinopathies, rotator cuff lesions, serratus anterior paralysis, subacromial impingement
syndrome, and adhesive capsulitis among these 44-65 percent shoulder disorders, contributing
to subacromial impingement syndrome.
Posterior capsular tightness is more common in overhead activities which increases the force
on shoulder joint which may cause posterior capsular tightness along with rotator cuff tear.
The active stabilizer for shoulder is rotator cuff which avoid the superior translation of
humeral head during shoulder abduction due to weakness of rotator cuff along with posterior
inferior capsular tightness the humeral head may translate superiorly and ultimately lead to
SAIS in which rotator cuff tendon long head of biceps and subacromial bursa impinge between
acromion superiorly and greater tubercle of humeral head inferiorly. Tears of the
subscapularis tendon are mostly the result of a degenerative process, but less commonly,
traumatic injury can result in acute subscapularis tearing. The most common mechanisms of
subscapularis injury are hyperextension and external rotation of the shoulder.6 The
infraspinatus (ISP) muscle, one of the rotator cuff muscles. Pain in the infraspinatus is
most likely caused by repetitive motion involving the shoulder. Swimmers, tennis players,
painters, and carpenters get it more frequently. It also becomes more likely as you get
older.
The serratus anterior play an important role in prevention of shoulder impingement by lifting
the acromion process in overhead activities. The most common pathologies of serratus anterior
is serratus anterior dysfunction which may cause scapula winging.8 In GHIRD glenohumeral
internal rotation deficit there is 18 to 20 degree of limitation along with glenohumeral
horizontal adduction and incomplete humeral rotation can lead to posterior capsular
tightness. Therefore, posterior capsular stretch is more effective intervention for posterior
capsular tightness.AC joint is responsible for shoulder disability and pain in inactive
patient and athletic activities including skiing, cycling and mostly in contact sports which
contribute 9 percent approximately of AC joint damage with shoulder injuries. Impairment of
AC joint effects range of motion, pain and weakness along with poor posture and these leads
to restriction in overhead activities.
The most frequent causes are posterior capsular tightness and rotator cuff tear involve
overhead movements such as swimming and volleyball and basketball, which have high-velocity
pressures on the joint shoulder.
In non-operative management of subacromial impingement, anti-inflammatory
mediction,subacromial injection of steriods, ultrasound, lifestyle changes, and physical
therapy management is normally given. Physical therapy is used to reduce the pain and enhance
the functioning of the SIS. Patients should attempt to discontinue overhead movements unless
symptoms diminish.
A pragmatic posterior capsular stretch (PPCS) is designed to stretch the posterior capsule
when it is in torsion.Pragmatic Posterior capsular stretch can effectively improve the
functional movements and shoulder ROM of healthy young adults.16 Another popular stretch is
the "sleeper stretch". There is a significant increase in posterior shoulder flexibility by
sleeper stretch.Scapular movement is restricted while performing the sleeper stretch and
accomplished by lying on the side to be stretched, elevating the humerus to 90° on the
support surface, then passively internally rotating the shoulder with the opposite arm.