Kinesiology THURSDAY – Medial Clavicle and Shoulder Impingement (Why Did That Work?!)
Kinesiology THURSDAY – Medial Clavicle and Shoulder Impingement (Why Did That Work?!)

“I wrenched my shoulder throwing around bags of mulch,” a patient told me. She demonstrated about 100Ëš of arm elevation before complaining of superior shoulder pain. She was unable to tolerate any resistance to shoulder abduction or flexion, typical signs of rotator cuff impingement or injury.
With the patient supine, I assessed her medial clavicle at the sternoclavicular (SC) joint and observed it was posteriorly displaced, meaning it was deeper than the uninvolved side. I corrected it by gently placing my thumb behind the medial clavicle to apply an anterior pressure while she actively protracted her scapula by reaching her arm to the ceiling for three repetitions. I then mobilized the lateral clavicle in the posterior direction (grade III) while stabilizing the acromion.
Immediately following the correction, she demonstrated full arm elevation, though there was still some pain with resistance to flexion and abduction. Two days later, she demonstrated 5/5 MMT of the shoulder with pain-free arm elevation.
Why did that work?!
The first 90Ëš of arm elevation requires upward rotation of the scapula with the axis at the SC joint. From 90Ëš-180Ëš of elevation, the scapula continues to rotate upwards with the axis of movement at the acromioclavicular (AC) joint.
Anatomical structure of the shoulder joint relationship between the clavicle and scapula
The SC joint is a saddle-shaped joint, meaning it is concave moving on a convex surface in the transverse plane (protraction/retraction), and convex moving on a concave surface in the frontal plane (upward/downward rotation).
Posterior displacement of the medial clavicle results in anterior displacement of the lateral clavicle, causing “impingement” type pain. The superior shoulder pain reported in this case was probably more from AC joint subluxation than impingement of the rotator cuff.
This type of subluxation may cause stretching of the SC and AC ligaments and require more than one correction, so it is helpful to teach the patient how to self-correct a posterior displacement of the medial clavicle.
Next time your patient experiences shoulder pain with arm elevation, be sure to check out the medial clavicle.
Because nobody has time to be in pain.
Until next time…
Kind Regards,
MoveWell Academy
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