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Copy of Case Study Presentation
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By:Kathy Fosnaugh OMSIII Background History and Physical exam: Treatment: Limitations: Results Any Questions? References: During my rotation here we saw several (4-5 patients) who complained of Decreased ROM, "popping in shoulder" and mid thoracic pain or muscle spasm.
All were treated with OMT which increased ROM and decreased their pain.
So, Why?, How did treatment work?
Osteopathic exam: --Shoulder abduction relies on the smooth abduction and rotation of the scapula along the ribs. If the patients rib is slightly displaced from its normal position, this could a "rubbing" of the scapula along the ribs causing pain and possibly the "popping" noise felt/heard by the patient.
--If the thoracic vertebrae are out of place this also affects the ribs attached to the vertebrae in turn causing the pain. In addition the Trapezius muscle point of origin is from the occiput, nuchal line and the spinous process of C7-T12 and inserts on the lateral clavicle, spinous process of scapula and later clavicle so, a problem with the thoracic spine could affect the tone of the trapezius and/or cause pain
--If there's a cervical spine dysfunction, this is where the innervation to many of the shoulder muscle comes from so, all of these muscle could potentially cause pain/muscle tension in the shoulder.
Hypothesis on why this treatment worked: Muscles involved in
Shoulder Abduction. Supraspinatus first 15deg then deltoid to 90deg.
Then Serratus Anterior rotates the scapula and trapezius contracts and shoulder moves past 90deg.
Serratus anterior innervated by Long thoracic (C5-7)
Trapezius innervated by accessory nerve
Deltiod innervated by the axillary nerve (C5-6)
None of these patients had any known injuries, pain had developed gradually over time (a few days to weeks)
All had decreased active abduction, 1 or 2 patients also had decreased external rotation
Passive ROM was close to normal but, painful
All special tests were negative indicating no rotator cuff involvement
Examine the upper extremity and all of the structures surrounding the shoulder including:
neck Findings: All of these patients had at least one finding in either their thoracic spine and/or ribs on osteopathic exam. All of the patients were treated with osteopathic manipulation.
HVLA -high velocity low amplitude the treatment that typically "pops bones" USED WITH CAUTION IN THE ELDERLY
Muscle energy - Uses the patient own muscles against physicians counterforce
Counterstrain- find tenderpoints and use positioning of patients in specific ways to relieve pain
Most of our patients were young and had very specific dysfunctions that were easily treated with HVLA and/or muscle energy
All patients reported a decrease in pain
All had some increase in range of motion
All but one patient had complete resolution of the Crepitus in the shoulder
Chronic pain - may be able to improve a little but, likely won't completely resolve with OMT
Recent surgeries, trauma etc
Research for OMT treatments is difficult
Results are often subjective hard to have a "no treatment" group
Often sham touch is used and shows subjective improvement.
Different providers treatment varies so, hard to develop treatment protocols
There are very few research articles available. Those that are available have very few subjects often less than 20 so very hard to quantify results