Chronic shoulder-neck syndrome
A 51-year-old woman came to my practice with long-standing shoulder and neck pain on the right. When she lifted her arm over the horizontal, the pain occurred. The movement was also significantly limited in this movement (high arm lifting, inflection).
There was no trauma in the anamnesis. She has a full-time sitting office job.
As operations in the abdomen, there was an appendectomy and an emergency operation in an ectopic pregnancy with a burst fallopian tube. She had two children at normal gravity and childbirth. During the osteopathic examination of the abdomen, in addition to a reduction in the urinary bladder and the uterus, significant adhesions in the right lower abdomen were noticed.
In the shoulder-neck area on the right side and in the thorax, there were various fascial disorders in the sense of tension. The ribs 2-5 on the right showed dysfunction in their joints to the sternum. The M. levator scapulae had trigger points on the right. There were no signs of impingement.
For me, the clearer finding was in the lower abdomen on the right. There I began my treatment and worked on the organs (urinary bladder, uterus, caecum, small intestine) mobilizing and against lowering. After a while, I asked the patient to raise her arm for control, which went significantly better than before the treatment. I continued to work on the abdomen and in the end the arm lifting had improved significantly in flexion, almost to the final degree. As a "homework" I gave her a self-mobilization for the abdomen. I only treated the shoulder-enclosing findings briefly, they no longer significantly improved the arm lifting in the first treatment. However, there was also a "homework" here: a self-treatment of the trigger point and a functional exercise to practice arm flexion.
My patient came to the second treatment, after four weeks, with significantly improved arm lifting and less pain. However, the abdomen was no longer in the foreground in this treatment, because a short treatment showed no further improvement in this treatment. The findings close to the shoulder came to the fore. This is how I treated the fascial disorders and the sternocostal joints. New in the second treatment as a finding, I found dysfunction of the N. suprascapularis on the right. I also treated him. At the end of the treatment, the high arm lift had improved again, this time so that the achievable extent of movement no longer caused pain. A final restriction was still present, in the sense of a capscular restriction. With mobilizing exercises, I dismissed them.
At the third appointment, there was still a residual symptom of about 10% of the initial value (pain and movement restriction). Even in this treatment, the organs were no longer in the foreground, nor was the joint capsule. Now it was muscular disorders that were responsible for the residual symptoms. In particular, it was trigger points in the supraspinatus and M. levator scapulae and the muscle attachments on the coracoideus process that were hypertonic. After the treatment of these structures, the rhomboid egg on the right was still painful in motion, there were also trigger points, which only became clinically relevant after the detonation of the other muscles.
It's like reading a story backwards: The older disturbances come to light later, but absolutely have to be treated.
So you have to raise your findings again and again and relate them to the current complaints. And as here in this case, the symptoms change over the course of a treatment series. As long as the direction is right, namely continuous improvement of symptoms, you must not be unsettled and stay tuned...both therapist and patient.
Self-exercises were supplemented by stretching with and without aids of the conspicuous muscles. A re-introduction was agreed