What is the treatment for difficulty with horizontal adduction?

Treatment for Difficulty with Horizontal Adduction

Horizontal adduction difficulty should be treated with a combination of soft tissue mobilization, stretching with scapular stabilization, and progressive strengthening exercises to improve range of motion and function.

Understanding Horizontal Adduction

Horizontal adduction refers to the movement of bringing the arm across the body in a horizontal plane when the shoulder is abducted to 90 degrees. Difficulty with this movement can lead to:

• Posterior shoulder tightness and glenohumeral internal rotation deficit, which are risk factors for shoulder injuries 1
• Increased forces on the shoulder and elbow during athletic movements, particularly in overhead athletes 2
• Functional limitations in daily activities and sports performance 3

Assessment Approach

Before treatment, proper assessment should include:

• Measurement of horizontal adduction range of motion using a digital inclinometer 2
• Evaluation of bilateral differences in total arc of motion to determine if restriction is due to soft tissue tightness 2
• Assessment of associated limitations in internal rotation, which often accompanies horizontal adduction restrictions 3

Treatment Options

1. Manual Therapy Techniques

• Instrument-assisted soft tissue mobilization (IASTM): Effective for improving horizontal adduction and internal rotation 1
• Soft tissue mobilization with scapular stabilization: Targets the posterior capsule and muscles while maintaining proper scapular position 3

2. Stretching Protocols

• Horizontal adduction stretching with scapular stabilization: Produces significantly greater improvements in both horizontal adduction and internal rotation compared to stretching without stabilization 3
  • Hold stretches for 30 seconds
  • Perform 3 repetitions
  • Ensure the scapula is manually stabilized during the stretch

3. Strengthening Exercises

• Serratus anterior strengthening: Combine with horizontal shoulder adduction to increase activity and strength of scapular protractors 4
• Progressive isotonic strengthening: Focus on rotator cuff and scapular stabilizers 5
• Core and lower extremity strengthening: Important for overall kinetic chain function 5

4. Rehabilitation Phases

For more severe cases or post-injury rehabilitation, follow a structured approach:

1. Acute phase:

   • Modalities: cryotherapy, ultrasound, electrical stimulation
   • Basic flexibility and posterior shoulder stretching
   • No resistance training initially 5

2. Intermediate phase:

   • Focus on internal rotation and horizontal adduction stretching
   • Progressive isotonic strengthening
   • Begin core strengthening 5

3. Advanced strengthening phase:

   • Plyometric program
   • Endurance drills
   • Short-distance functional movements 5

4. Return-to-activity phase:

   • Progressive interval program
   • Sport-specific exercises 5

Special Considerations

For Athletes

• Limit arm abduction to 90° during training and rehabilitation to decrease risk of brachial plexus neuropathy 5
• For baseball players and overhead athletes, address horizontal adduction limitations early, as restrictions of -10° or less are associated with increased shoulder and elbow forces 2
• Implement proper rest periods between training sessions to prevent overuse injuries 5

For Post-Surgical Patients

• After medical clearance, begin with gentle stretching and advance program as soreness rules allow 5
• For tendon/ligament injuries, follow a more conservative progression with appropriate rest days between sessions 5

Potential Pitfalls and Caveats

• Avoid excessive stretching: Overstretching can lead to joint instability, particularly in patients with hypermobility 5
• Monitor for neurological symptoms: Horizontal adduction stretching with excessive pressure can compress neurovascular structures 5
• Recognize individual anatomical variations: Some patients may have structural limitations that restrict full horizontal adduction 5
• Balance mobility with stability: Excessive focus on mobility without addressing stability can lead to shoulder dysfunction 5

By implementing this comprehensive approach to treating horizontal adduction difficulties, clinicians can effectively improve range of motion, reduce pain, and enhance functional outcomes for patients.