Case Study
42-Year-Old Female presented with Lack of Movement in Left Shoulder

A 42 year-old woman presented with pain in the left shoulder and could not raise her arm above her waist.

In April, 1998, the woman rolled over in bed in the morning and felt pain in her left shoulder.  The pain continued to increase to the point where she could not tolerate the weight of a blanket at night.  With the increase in pain came decreased range of motion. The arm became increasingly stiff and she could move it less and less each day.

The patient went to a chiropractor that did a neck adjustment, which increased the pain and significantly reduced range of motion.  She went to another chiropractor, which diagnosed a frozen shoulder.  He made spinal adjustments and did stretching modalities on the arm with no results. He referred the patient to an orthopedic surgeon.  The surgeon gave a cursory examination and pronounced that the problem was in the patient's neck and wanted to do neck surgery.  He administered strength tests and said the patient had lost muscle mass and needed immediate surgery to correct the neck problem in order to recover any movement in the arm.  The patient rejected his recommendations but continued to see the chiropractor weekly.  She then visited an Oriental Medical Doctor and Acupuncturist.  This doctor also diagnosed a frozen shoulder and tried to force movement.  The acupuncture he did relieved 90% of the pain at rest, but restored no movement.  The patient saw him approx. three times.  All of the doctors looked only at her shoulder or neck.

Patient called us after seeing an article about us in the newspaper.  She felt that the description of fascial problems in the paper fit her situation.

At her first visit, we did an evaluation where we found the patient had poor posture with a forward head, rounded shouldered and slumped position.  She was in a "pain posture" where everything is locked down.  There was tightness across the pectoralis and anterior shoulder, little to no scapular glide, tightness throughout the whole shoulder girdle and increased thoracic kyphosis.  Active range of motion bilaterally was very poor, left more involved than the right.  Arm could not be raised to 90-degree shoulder flexion or abduction.  She had no external rotation or supination.  She had significant pain throughout the entire extremity with any movement.  The pain was so great that it was difficult to decide where to start treatment.  We determined that prior therapy had worked only on the shoulder but her problem was due to the fact there was no scapular glide.  No previous therapy had ever looked at scapular glide or looked at postural alignment. 

We chose to go to the scapula to improve range of motion to at least 90 degrees to improve function in order to facilitate normal movement patterns and decrease pain levels.  We began doing light arm pulls in supine position to eliminate gravity from the system and facilitate extremity to unwind (untangle) itself.  That allows the body to tell us what it needs.  We then did a crosshand to open her pecs with an occipital release. 

After the first treatment the patient was able to get her arm to 90 degrees.  She reported some pain from the treatment but seemed to feel there was an overall decrease in the pain she was having.

We continued to see her on a weekly basis.  Due to the complexity of her situation and the involvement of so many body systems, we used the body's inner wisdom to guide us in what needed to be done and when. We used various techniques.

When we got the scapula to free up so there was minimal scapular motion, we did scapular mobilization techniques.  This freed the scapula, which freed up the gleno humoral joint and the clavicle.  We continued to work on those to keep movement. Arm pulls seemed to work best and allowed the arm to unwind which guided us through the process.

After initial improvement in the left arm, the right arm began showing signs of the same problem. After several months of treatment, the patient was able to raise the arms above her head and behind her back. She had 100% use of both arms.

We continue to see this patient on a weekly basis as we continue to balance the body and address other issues that have been with this patient throughout her life. 

This website last updated on 31 July 2010

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