Sore right shoulder and neck

A 46-year-old woman. Complains of pain in back of neck and shoulder on the right side, severe limitation of mobility in the shoulder, sore neck movements. Suffering for over 5 years.

Objective examination: abduction is about 80%, putting the hand behind the back - at the level of the iliac crests of the pelvis. Tilting the head to the left is very limited and causes pain in the left supra-shoulder, to the right in full. The sternoclavicular joint on the right is blocked. There are numerous functional joint blocks in the mid-cervical and upper thoracic regions, the paravertebral muscles are tense, painful on palpation. A pronounced myofascial syndrome of the scalene muscles, when pressed, provokes a characteristic referred pain deep in the shoulder, along its anterior surface and elbow. The right first rib is elevated, respiratory movements are almost absent.

Diagnosis: complex shoulder disorder, myofascial pain syndrome of the rotator cuff muscles of the shoulder, especially the infraspinatus. Functional articular blocks of the mid-cervical region (C4-5, C5-6) with irradiating pain to the left shoulder and right shoulder. Blockages in the thoracic spine and corresponding ribs, first rib on the right.

The treatment: mobilization of the vertebral segments C4-5, C5-6 (physiological movements along the articular surfaces) with the use of strengthening movements of the neck and shoulder. Muscle energy techniques and passive mobilization for the first rib, sternoclavicular articulation. Technique of progressive increase of pressure (variant of point massage) for the scalene and paravertebral muscles. Method of cooling with coolant and stretching for the infraspinatus muscle.

The following results: restoration of completely pain-free volume, with frontal deviation of the shoulder already after the first two sessions, tilting of the neck to the left after four sessions. Abduction of the right arm behind the back up to the shoulder blade (as in a healthy arm) fully restored only after 8-10 sessions. Discomfort between the shoulder blades disappeared. Recommendations were given for maintenance of improvement achieved.

Pain in back of neck and shoulder right side. Conclusions.

I remember this case very well, because the patient felt that her condition gradually improved and she was an intelligent and conscientious person who came to see me more than 10 times and followed all the recommendations diligently. Also the patient had many different disorders, which influenced on each other in a complicated way. At the first session, with gentle mobilization of the fifth vertebra, the just painful abduction of the arm became completely painless and after two sessions did not come back again. That made a great impression on the patient and proved the connection of at least part of the pain in the right shoulder with the cervical region. The scalene muscles, which restrict the arm behind the back, were much less amenable to treatment. The breakthrough came after the use of a cool-down stretch, a favorite technique of Janet Travell (a pioneer of trigger point studies). The case illustrates that the presence of one disorder in no way excludes the presence of a second, or third... Therefore, it is important to always be open to new information and to change the therapeutic approach if necessary.

Grigori Tafi
Osteopath, sports medicine doctor
15 years of experience in osteopathy and manual therapy. Read more...

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