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A Viscerosomatic Discovery: Unveiling a Case of Gastroparesis Disguised as Shoulder Pain

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 19. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

case report [708]
female [597]
gastroparesis [5]
OMT [3751]
osteopathic manipulative treatment [3771]
shoulder pain [27]
women [553]

Abstract:

Introduction/Background: Gastroparesis, characterized by delayed gastric emptying due to iatrogenic, immune, or idiopathic causes, commonly presents with nausea, vomiting, decreased appetite, postprandial fullness, bloating, and weight loss. Although rare, shoulder pain has been associated with gastroparesis, with limited literature on viscerosomatic findings in non-diabetic cases. This case describes shoulder pain caused by viscerosomatic reflexes linked to underlying gastroparesis. Case: A 39-year-old female with iatrogenic gastroparesis secondary to gastric sleeve surgery one year prior presented to the osteopathic treatment center with persistent nausea and daily vomiting for three months despite dietary modifications and medication adherence. She also reported constant left-sided, “achy” shoulder pain that worsened after work and following vomiting. She underwent two osteopathic manipulative treatment (OMT) sessions, reducing her shoulder pain from an 8/10 to a 3/10, before being referred to her original GI specialist for revision surgery due to continued emesis. Post-surgery, her gastric symptoms resolved, but shoulder pain persisted. Physical exam revealed hypertonic trapezius and scalenes, taut rhomboids, left bicep and subscapularis tenderpoints, left exhaled ribs 3 and 4, and T3-T6 NRLSR. OMT included OA decompression, muscle energy, ligamentous articular strain (LAS), counterstrain, and high-velocity low-amplitude (HVLA) techniques. Results: Eight weeks after revision surgery and two OMT sessions, pain reduced from constant to intermittent, with complete resolution reported days after of the final OMT session Discussion: This case highlights a unique instance of shoulder pain caused by viscerosomatic reflexes associated with gastroparesis. This case underscores the importance of recognizing viscerosomatic changes in common gastrointestinal conditions and calls for further research on these reflexes associated in the context of prolonged emesis. Limitations of the case include recovery-related dysfunctions resulting from prolonged immobility.


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