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Restricted Shoulder Range of Motion: A Neglected Component That May Surprise You

Journal: The AAO Journal Date: 2022/06, 32(2):Pages: 23-24. doi: Subito , type of study: case report

Free full text   (https://meridian.allenpress.com/aaoj/article/32/2/15/482674/LBORC-NUFA-Poster-Abstracts-2022-Students)

Keywords:

case report [514]
myofascial trigger points [9]
OMT [2951]
osteopathic manipulative treatment [2973]
range of motion [80]
shoulder [96]

Abstract:

Introduction/Background: Myofascial trigger points (MTrPs) are a common finding on osteopathic screening exams (OSE) in patients presenting with restricted shoulder range of motion (ROM). Of the rotator cuff muscles, the subscapularis has been identified on the differential for such pathologies. Many mechanisms for these conditions have been proposed; however, the identification and release of MTrPs as a primary etiology has been far overlooked. Case: A 24-year-old male presented with a 3-month history of restricted abduction of the left shoulder. He denies an inciting event and now reports an inability to perform any activity overhead. Physical exam demonstrates limited abduction, left shoulder restricted to 90°, painful hypertrophic distal subscapularis, and mild discomfort with Jobes empty can and Neers. On OSE, a myofascial trigger point was noted in the ipsilateral subscapularis. Osteopathic manipulative treatment (OMT) was directed at treating the MTrP with direct inhibition. Additionally, rehabilitation was aimed at scapula stabilization (low trapezius and serratus anterior). Results: Following OMT, the patient experienced immediate return to full, unrestricted range of motion of the left shoulder. Follow up 4 days later, he had returned to unrestricted activity. He continues to have unrestricted range of motion at a four-month e-mail follow up and attributes this improvement completely to OMT. Discussion: This case study suggests that treatment of myofascial trigger points using OMT can be a viable treatment modality in patients presenting with limited ROM with a MTrP on exam. Furthermore, the identification of subscapularis MTrPs should not be overlooked in shoulder pathologies involving restricted abduction. A limitation to this study is small sample size (n=1); future research should be aimed at expanding the sample size to increase generalizability.


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