Manual Therapy for a ‘Catching’ Shoulder

I recently saw a client who presented with a one month history of ‘catching’ pain in the shoulder.

The client recalls reaching overhead which precipitated the pain and has noticed intermittent pain since then with varied movements.

The client presented with a mild anteriorly migrated humeral head and no other significant postural defaults.  Shoulder ROM was limited with external rotation at zero degrees abduction only, all other movements were normal.  A mild strength deficit was noted with external rotation tested at zero degrees of abduction.

Other findings included:

hypomobility of the superior anterior GH capsule, hypermobility of the posterior middle capsule, thickening of the long head of bicep’s tendon, hypertonicity of the infraspinatus muscle and bicep’s muscle.

My thought on this case was that the hypermobility of the posterior middle capsule (likely from a previously unrecalled minor trauma) caused a hypertonic response in the infraspinatus muscle, which then caused the humeral head to migrate anteriorly.  This anterior migration may have triggered irritation of the long head of the bicep’s tendon causing its synovial sheath to thicken.  The thickened synovial sheath was the factor causing the ‘catching’ pain.
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SO NOW WHAT?

I used manual therapy to treat the problem.

I targeted the bicep’s muscle and tendon with massage to release tension and increase circulation,  I then targeted the infraspinatus muscle with a dry point needling technique to release its tension.  And finally, I mobilized the anterior superior capsule with an inferior glide and external rotation technique (glide and wind).

The end result after one treatment was a dramatically improved external rotation motion with no ‘catching’ pain and ultimately a happy client!  The client was sent home with a re-patterning exercise for external rotation and will be followed up.

The point is that sometimes a few simple manual therapy techniques such as massage and mobilization can make the world of difference…

Speak Soon!