soreness on top of shoulder and upper arm

[Pompal 09.]

HI,

I think this should be a really easy one, which is why I'm frustrated! I'm a new therapist. This man has had shoulder and arm soreness for siz weeks (much more detail below). I've worked on him twice in the last week: The first time he felt pain-free for two hours, then the shoulder started seizing up again, and, he said, MORE FREQUENTLY although the pain wasn't more intense. The second time, he started the massage n pain, felt pain-free 3/4s of the way through the massage, and began to seize up again in the last ten minutes. Here's more background info:

His pain is on the top of the shoulder (upper trap, supraspinatus, infraspinatus at insertion to humerus) that sometimes moves into upper arm AND all the way down to outside of the pinky. He says it's NOT a shooting pain or a bad pain, merely a nagging muscle soreness, but really nagging. He's had it for six weeks and thinks he got it sleeping (on his stomach, sometimes with head up and back on a pillow, shortening lev scap and splenius capitis). It will wake him in the night. He can make it go away by working on TPs in traps, infraspin and rhoms and with stretching, but it always comes back in a few hours. He can reproduce it by tilting head to opposite shoulder, and we can reproduce the pain down the arm by working the insertion of the infraspin at the humerus (which is REALLY bound up). Otherwise, the areas that seem very seized up are all traps and especially upper, the rhoms on both sides, the upper 2/3rds of the scalenes, and the insertions of the supraspin and infraspin. (Hope you're all enjoying my abbrevs.)

The first session (one-hour a week ago), I worked:

rhom, subscap, infraspinatus, supraspinatus, traps, scalenes, lev scap

All but subscap and lower traps seemed involved but seemed to release easily.

He felt pain-free when he left and for a full two hours, then it seized up as if he had never had a massage, AND he said it seemed to be seizing up MORE FREQUENTLY although not hurting more. The second session a week later, his shoulder seemed much more seized up than the first time, and as if it were having trouble relaxing, and I was not getting good releases.

I worked all the above plus pec major and minor, coracobrach, deltoid and triceps.

After an hour of work (forty minutes prone), he sat up, tilted his head to the side to check, and said he again felt pain-free. He lay down again and I started working the other shoulder, and the 'bad' shoulder started to seize up for the first time in the massage. We noticed it at the same time: I found myself returning to the rhomboids on that side and saying, "wow, these seem newly tight" just as he was saying, "it's starting to hurt again." The neck muscles did not seem strained in the headrest, though I wondered at that option. But he left, it seems, back at the beginning. And is coming back next Wednedsay.

I'll check in with him today and tomorrow, but...any ideas?

THANK YOU!

 

[Adara]

Try working the opposing muscles.....ack, what is my word here?? pecs, subscap, SCM, biceps.. In my experience, the subscap and pecs cause tons of shoulder pain that is felt elsewhere, and definitely the traps (and scalenes) cause the rhomboids to be very hypertonic and painful.

 

[Glorio]

:iagree: yeah, what she said.
I would revisit the subscap in particular and check for trigger points. I used to have dreadful TPs in my subscap and my therapist educated me about how the subscap TPs can refer pain to the top of the scapula. Once they were effectively worked with, the pain went away when nothing else had worked before.

 

[Abigael]

You might want to try along with what was said before doing some PNF work. If you strengthen the stretched better it could help a lot.

How's his posture? Are his shoulders IR-ed and protracted? Are the shoulders uneven?

 

[Giddyup Giddyup]

Try working the opposing muscles.....ack, what is my word here??

Are you thinking of "Aneforum.xxxonist?"

Angie

 

[trackman]

Physical work aside, make sure your client is drinking plenty of water, and you may want to ask him about his diet & physical activity as well.

If he drinks lots of coffee, and/or is a classic type A personality he has to make some life-style changes. Meditation, Yoga, or other relaxation methods may be of some help, along with taking magnesium, etc. would be helpful.

 

[so.moon]

Try working the opposing muscles.....ack, what is my word here??

Are you thinking of "Aneforum.xxxonist?"

Angie

YES!!!!!!! Thank you!! lol......whew!! I feel better now. I NEED words!!

 

[Sexy Dude]

It sounds as though you are doing a good job, remember if he only recently (6 months is recent enough) started having problems, whatever he has been doing to create this imbalance has been going on for longer than that and you won't be able to help completely relieve the area in just two sessions.

Some things that may help is to focus on the pectorals and the serratus, both will refer down the arm into the pinky fingers. And work all the areas you have been working as it is possibly a combined muscular issue.

Also, the order in which you work muscles can really make a difference. Try working supine for the pecs, subscap, levators and scalenes first before working the posterior muscles. Some areas won't loosen until you work others first. For example, the sup traps might not loosen until the levators are worked first.

Other clues would be a thorough intake, how does he sleep, what does he do all day, how does he perform these activities, etc. These can all help you determine what is going on and you can give suggestions on how he can perform these duties better or what positions to avoid if you have understanding in these areas.

Don't give up, these things can take time and it can become a little worse before there is improvement. If a client has had pain in an area, guarding can create more problems than anything else so just go gently patience is the key!

 

[YahooUser]

Thank you so much everyone! You're amazing. I really love this forum. Kathryn thank you especially for the reminder of patience. I was caught off guard that the fix hadn't stuck--a big lesson to me--and then that it started seizing up again while he was on the table, and I sort of panicked. It made me immediately want to refer out since he was in too much discomfort for me to subject him to my learning curve (he's only had it six weeks though I know the muscle imbalances are older). He's decided to try a chiro (?) AND I did give him the name of another MT, so I will let you know if there's an update! Thank you so much for the support. It's truly aMAzing!

 

[MJ_Lover_OX]

ONe other thought for you...........

with mention of the effects of this upper arm difficulty radiating into the pinky finger, have you thought about working around the elbow joint itself to ensure that there are no muscular spasms having any effect on innervations that serve the hand, especially the 5th digit?

And, I will 2nd the idea of working supine first to loosen things up for your client. Most of the really good work I have been able to do in releasing troublesome traps and deltoids begins w/ clients supine and letting gravity and different techniques do the work for me.

 

[shesxchaotic]

Everyone else has given you really great advice so I'll just throw this other thought in there - sometimes with clients who are experiencing chronic pain it can be helpful to ask some questions about posture and habits to find out if there is anything contributing to the pain/tension cycle.

For example - I had a client with severe hip/low back pain. It would release almost completely after a session only to return within about a week. When we got to discussing things I found not that not only did he usually carry a large wallet in one back pocket, but he also often sat on one foot creating constant imbalance in his pelvis. Once he was able to break those destructive (physically damaging) habits he felt better longer.

Is your client on the phone a lot? If so make sure he isn't tilting his head when he talks on the phone.
Computer? Check his posture.
DRIVING? (Sometimes, men especially, drivers will use just one hand on the top of steering wheel causing that entire shoulder region to be elevated AND held in tension)

What are his usual habits and what is his occupation?

Blessings, Angela

 

[Hunnuhx]

Upper shoulder and arm pain.

All good suggestions and certainly worth trying, since pain can be referred from lots of places, and each body has its own patterns of referral.
A chiro would be my recommendation next, because an impinged nerve in the neck or upper thoracic can cause problems that you would swear are muscular in origin.
(This guy sleeps on his stomach? Often? Not good for your average person over 3 years old!)
If the chiro finds nothing out of alignment, I would try working scalenes and the deep cervical muscles, because nerve impingments can be a result of tense muscles, also.
Would facia problems be a possibility?

 

[SIR]

Thoracic Outlet?

Hello,
I agree with a lot of what was said above. Working a lot of TrPs is a good idea, and it sounds like you were working in a lot of the correct areas. The pain he is having souns a bit like Thoracic Outlet Syndrome. The Brachial Plexus is the area that sounds like it may be impinged a bit.

This is a bit out of one of my school texts.

"The brachial plexus is situated partly in the neck and partly in the axilla and provides virutally all the nerves that innervate the upper limb. Any imbalance that brings pressure on this complex of nerves results in shoulder pain, chest pain, arm pain, wrist pain, and hand pain.
The muscles most often responsible for impingement of the brachial plexus are the scalenes, pec minor, and subclavius. Muscles of the are occasionall impinge branches of the brachial plexus. Brachial plexus impingement is responsible for Thoracic Outlet symptoms, which are often misdiagnosed as Carpal Tunnel Syndrome."

I just read this thread which I found to be very helpful with my symptoms (which sound very much like his)
http://www.massageplanet.com/forum/viewtopic.php?t=11813&highlight=
hope this helps!