Shoulder Range of Motion Changes with the Use of Integrative Manual Therapy
Author: Suzanne Simons, MPT, IMP,C
Abstract: The woman in this case study was 48 years old and complained of left shoulder pain and paresthesia with a limitation of motion. The patient reported that she had difficulty performing activities of daily living involving her left arm due to this pain. The woman received treatment with Integrative Manual Therapy for one session of two hours. Prior to treatment, the patient presented with limitations in range of motion of her left shoulder as well as postural deviations. After treatment was completed with a focus on upper quadrant, the patient presented with a significant improvements in posture and increased range of motion of that arm. The paresthesia was eliminated and the woman reported increased functioning. The woman regained full use of her left arm.
Key Words: Shoulder, Paresthesia, Bone Bruise
Background
The patient is a 48 year old female with complaints of left shoulder pain with limited range of motion, making it difficult to perform activities of daily living such as reaching overhead and dressing. Mild paresthesia was reported in the 4th and 5th digits of the left hand. Symptoms became evident 24 hours after the patient played golf for the first time in twelve years. Pain intensity in the affected shoulder increased from 3 out of 10 to 5 out of 10 (on a Pain Analog Scale) within the ensuing 48 hours. The patient was seen for treatment 4 days post-injury.
Past Medical History
The patient reported childhood vaccinations in left upper extremity as well as a severe fall on her right side while holding onto a child with her left arm in June of 87'.
Examination
Posture/Observation: The patient’s left shoulder girdle appeared to be significantly elevated and protracted.
Range of Motion:
Left shoulder estimated, uncompensated range of motion:
| Flexion |
85°
|
|
| Abduction |
80°
|
Pain reported as 5 out of 10 in triceps area at end of range |
| External Rotation |
80°
|
|
| Internal Rotation |
45°
|
Increased paresthesia reported |
| Hand Behind Back | thumb to L5, with pain reported in deltoid area | |
| Hand Behind Head | thumb to mid-occiput |
Right shoulder estimated, uncompensated range of motion:
| Flexion | 150° |
| Abduction | 140° |
| External Rotation | 90° |
| Internal Rotation | 45° |
| Hand Behind Back | thumb to T3 |
| Hand Behind Head | thumb to T5 |
Treatment
Treatment was performed during one session of two hours duration. The following techniques were utilized:
Advanced Strain and Counterstrain for the left subclavian artery 1; Compression Syndrome of the left brachiocephalic vein 2; Disruption of Membrane Technique at the left subclavian artery and left braciocephalic vein 3; Osseous Compression Syndrome of the left clavicle 2
Bone Bruise Technique of the left clavicle and coracoid process 4; Myofascial Release of the left clavipectoral fascia 5.
Results
The patient's left shoulder range of motion significantly improved, with subjective pain level reported as having resolved immediately following treatment. Paresthesia was reported resolved within 24 hours. By observation, patient's left shoulder no longer appeared protracted and elevated after treatment. Measurements were as follows:
Left shoulder estimated and uncompensated range of motion post-treatment:
|
Motion
|
Before
Treatment
|
After
Treatment
|
| Flexion | 170° | 85° |
| Abduction | 160° | 80° |
| External Rotation | 90° | 30° |
| Internal Rotation | 70° | 45° |
Follow Up
Conversation with patient one week post-treatment revealed that she had regained full functional use of her left upper extremity.
References
1. (Weiselfish) Giammatteo, Sharon, Ph.D., P.T., Giammatteo, Thomas, D.C., P.T.. Integrative Manual TherapyTM for the Autonomic Nervous System and Related Disorders. California: North Atlantic Books, 1977.
2. (Weiselfish) Giammatteo, Sharon, PhD.,P.T.. DCR Course: Upper Extremity Compression Syndromes.
3. (Weiselfish) Giammatteo, Sharon, PhD.,P.T., DCR Course: Diaphragm Compression Syndromes.
4. (Weiselfish) Giammatteo, Sharon, PhD., P.T.. DCR Course: Type III Dysfunction of the Spine and Extremity Joints with MET and 'Beyond' Technique, with Bone Bruises.
5. (Weiselfish) Giammatteo, Sharon, PhD., P.T.. DCR Course: Myofascial Release Technique.