The patient presented with shoulder pain from a car accident that happened 3 months ago. The patient said that he had been to a physician and no diagnosis was given because nothing wrong could be found. Nevertheless, the pain persisted and a solution was still being sought after. Massage therapist to the rescue, “My thoughts go to superman with the chest sticking out come to save the day”. I am taking a class which covers just such a topic. Since the doctor could not find anything wrong, doesn’t mean that there is nothing wrong.
I swing into action asking the standard intake questions that are on my intake form first to rule out the obvious issues first. Like what medications are you currently taking and are you already under a doctor’s care. I switched gears and started to assess the shoulder to see if I can tell where the issue may be. Which shoulder is it that the pain is in? Right or left, the patient kindly remarks that it’s in my right shoulder. I immediately ask almost by instant knee jerk reaction, “Are you right handed?”
A light turns on and I remember that I could refer back to my shoulder pain assessment worksheet/form in the sport massage book on page 50, but before I did that I first asked the patient, “Is there any particular movement of the right arm that you can do that causes a sharp or dull pain?” Normally, the problems that we face in life are ones that are staring us in the face. The answer surprised me because he came back saying, “No, not particularly”.
So I started going through the motions to see if I could figure out through assessment what was going on. So the patient actively raised his arm above his head without any issues. Asked the patient to actively abduct the arm no issues found. Asked the patient to actively adduct the arm he didn’t complain of any issues the first time he did this movement.
I switched to passive movements of the arm and felt that when moving the arm no feeling of anything grating or hindering the movement of the arm. I did passive elevation and noticed that when I did the movement, that a little soreness was found when I moved the arm above the head. Not because of what he said, but because I was watching his face and it told me more than what the patient was verbally telling me. I still checked for passive abduction, lateral rotation, mediation rotation and finally horizontal rotation all presented as sore but no lack in range of motion and the end points all felt natural.
Moving down the list of possible issues, I switched again to resisted abduction and adduction of the arm. I noticed that abduction was quite forceful when he did the movement and I resisted his arm. Then I did a resisted adduction of the arm and pain along with weakness was found. Moving down the list I also went a step further and did the resistive lateral rotation and found that the force was much like it was when I did the abduction test.
So, I noted things and continued on trying not to let the patient know what I suspected could be wrong. Resisted medial rotation and elbow flexion lead to no issues, and finally the same results when resisted elbow extension was done. So I asked the patient to stand up straight in front of a postural chart to see if he was favoring a bad posture. Did notice that he favored his right side when he shifted his weight but no other abnormalities where found.
I suspect that he had issues in the pectorals, Latissimus dorsi, and teres minor and teres major. So doing a little more investigation I started to palpate the suspect muscle(s) groups. I found that the pectoralis major and minor where tight and thread like. The Teres major and minor where the same. So I told the patient I could spend some time treating the soft tissue but it the pain lingers after the massage that I would like to refer him back to his primary physician with some information. I would write up SOAP notes and fax them to this doctor. He wanted me to do some stretching, effleurage, petrissage on the muscle to see if we could work out some of the thread like features of the muscles so to stimulate the healing process. I also told him that no matter what I could not solve this issue in a single 1 hour session. Muscle fibers take time to heal and added that I may have to do cross fiber friction to break up and lesions that I find so that the soft tissues could heal properly.
Where still working on his treatment, I hope to see him back a couple more times but after the first treatment I saw improvement on the range of motion and comfort level when he was actively moving his arm through the plains of motion that I asked him to test.