FEB 8th – 2012 “F8mins”

Frozen Shoulder and 8 minutes.

(Click for link) Adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.I saw a new patient two days ago by the name of Natalie (anonymous name). She came in for a routine session and had no real focus. She advised me to mind her ‘frozen shoulder’ and to be weary of its very limited ROM (Range of motion).Frozen shoulder, or adhesive capsulitis, refers to the surrounding tissue and capsule of the shoulder cavity becoming inflamed and swollen (click picture for more info). This can lead to other related musculature becoming tight, diminishing of ROM, reduction in the quality of motion (ROQ), and PAIN!

After some warming, extreme scar tissue was assessed to be present near the insertion of the Rhomboid Major muscle at the inferior angle of the scapula. The rhomboids connect from the inside edge of your shoulder blade, up a few vertebrae to your spine. They help hold the shoulder blade, shoulder, and arm onto the rib cage, and assist in stabilization of the shoulder. These muscles also bring the shoulder blade towards the spine, and help to “draw the arm downwards.” I believe this scar tissue is very much related to the ‘frozen shoulder’ diagnosis 5 months ago. She has been living with the injury for approximately 1 year, and it affects Natalie’s non dominant hand. Natalie addresses patients and performs clinical duties during her daily shift. Post diagnosis Natalie has had Cortisone shots twice, once deep into the center of the gleno-humeral joint cavity (Shoulder), and also attended several Physical Therapy sessions to address this problem specifically.

Shoulder Blade, Capsule, & Related Musculature
(Left) The Insertion points for Rhomboid
(Right) Teres Minor & Teres Major
(Note) Triceps Brachii

Working the anterior portion (front side) of the body, I found her Pec Major muscle to be severely tense and swollen. Upon assessment her Teres Major muscle was found to be severely tense, riddled with trigger points and scar tissue, and very tender to work on. Her Teres Minor muscle was impossible to work on, it was so buried under swelling and tender scar tissue. Sub-scapularis was pretty swollen, but with some “custom”-MFT (myo-fascial technique), the muscle relaxed very quickly.

I worked on these related structures for approximately eight minutes in total (Pecs (2), Teres(2), and Sub Scapularis [see last post for more info]). The focus was on these few muscles, but all the related musculature was warmed, and thoroughly stretched & addressed prior to deep work on the aforementioned.

Natalie expressed that the treatment was rather painful, but not traumatically so. The pain during the treatment was expected, and did not surpass her expectations or boundaries. A few minutes post treatment, she expressed immediate relief from prior symptom related pain levels.

The work done on Natalies shoulder was done during the last 8 minutes of a 50-minute “relaxation swedish massage session.” During the initial assessment Natalie expressed interest in exploring therapy for her shoulder problems specifically, but also wanted focus on her whole body, and the main aim was for relaxation and some clinical benefit.

I saw Natalie the subsequent day for a 90-minute session. She reported having a %50 increase in overall ROM, diminished pain & symptoms, and a lot cleaner quality of motion from her arm and shoulder. She also mentioned  that NO OTHER THERAPY has addressed her problem so precisely, quickly, and efficiently. More about the second visit in the next entry…

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