The Benefits of Integrative Manual Therapy on Limited Shoulder Range of Motion

Author: Denine Savage PT

Abstract: This case study focuses on a 59 year old woman with diagnoses of Rheumatoid Arthritis and Osteoarthritis. Upon evaluation, the patient presented with limitations in shoulder range of motion. The woman received treatment with Integrative Manual Therapy, focusing on her shoulder. Following completion of treatment, the woman presented with significant increases in shoulder range of motion.

Key Words: Rheumatoid Arthritis, Osteoarthritis, Shoulder, Range of Motion (ROM)

History

This case study focuses on 59 year-old woman with diagnoses of Rheumatoid Arthritis and Osteoarthritis. She stated her pain began approximately ten years ago in her knees and gradually progressed to diffuse joint pain. Previous medical history also includes a motor vehicle accident 10 years ago with injury to the knees, bilateral fractured ankles and left wrist fracture. Daily medications include Celebrex 400 mg, Prednisone 7.5 mg, Pepcid 20 mg, Calcium and Vitamin D 1500 mg and Potassium 20 mg. The patient stated she had weaned off all medications recently, because she believes they cause her blurry vision and fatigue. However, she had severe onset of pain in the knees, all joints of the upper extremities and her neck. She was unable to perform her job as a medical secretary or enjoy social activities. She consulted her MD and has been back on the above-stated medications for 2 weeks with a subsequent decrease in pain.

The patient presented for an evaluation with the goals that Integrative Manual Therapy (IMT) could benefit her functional level, provide pain management, and ultimately allow her lower levels of medication.

Evaluation

At her evaluation visit, passive, uncompensated, supine range of motion (ROM) for the left shoulder was noted to be limited as follows: flexion 40 degrees, external rotation –15 degrees, abduction 40 degrees. Myofascial Mapping () was positive (indicating an area of dysfunction) over the entire left shoulder girdle, left thoracic outlet, left pectoral areas and left neck.

Treatment

The patient was treated with IMT for a 25-minute period with the following techniques: Bone Bruise Technique () to the left coracoscapular joint; Disruption of Membrane Technique () over the coracoclavicular ligament.

Outcome

After the first treatment was completed, the patient presented with the following ROM improvements in passive, uncompensated, supine range of motion for the left shoulder: flexion 90 degrees, abduction 90 degrees (a 50 degree increase) and external rotation 5 degrees (a 20 degree increase). Myofascial Mapping (1), when repeated, resulted in negative mapping at the left thoracic outlet, pectoral area and left neck. Mapping remained positive only over the left glenohumeral joint itself. This area would benefit from further treatment. The patient will follow-up with further IMT to pursue her above-stated goals.

References

1. Weiselfish-Giammatteo, S. Myofascial Mapping. Dialogues in Contemporary Rehabilitation, 1997.

2. Weiselfish-Giammatteo, S Bone Bruises and Bone Bruise Technique. Cranial Therapy Series Course Three. Dialogues in Contemporary Rehabilitation, 1998.

3. Weiselfish-Giammatteo, S Disruption of Membrane Technique. Visceral Mobilization with Muscle Energy & Beyond Tech. The Gastrointestinal Tract. Dialogues in Contemporary Rehabilitation, 1998.