Center for Health and Optimum Performance
1269 Barclay Circle
Marietta, GA 30060
Christi Osborne, B.S.
Student Clinician, Life University College of Chiropractic
2039 Powers Ferry Rd. Apt H
Symrna, GA 30067
Advisor: Dr. Rectenwald
Objective: The purpose of this case study is to provide a detailed report on the symptomatic improvement of a patient with shoulder pain with accompanying toe pain following adjustments to correct vertebral subluxations with Thompson technique.
Clinical Features: A 59 year-old female presented with right shoulder pain, and foot pain and was evaluated using palpation, posture analysis, thermography, range of motion, leg length inequality and chiropractic radiographic analysis. She was diagnosed with subluxations in the cervical, lumbar and pelvis regions as well as right shoulder arthralgia with osteophyte formation and right toe arthralgia.
Interventions and Outcome: Treatment consisted of Thompson technique to address subluxations. The patient’s symptoms resolved following 26 chiropractic adjustments and she was still free of symptoms at an 11 month follow up. Improvements in ranges of motion and thermography were noted along with the patient’s subjective report of improvements in strength of right arm and absence of pain in shoulder and foot.
Conclusion: Further investigation is warranted on the relationship between subluxation in the cervical spine and shoulder pain. Chiropractic care may benefit patients with upper extremity pain and symptoms.
Key Words: Thompson, Shoulder pain, Subluxation, Chiropractic.
Shoulder problems are common, with 1 in 3 people having shoulder pain at some point in their lives 1. As far as musculoskeletal pain syndromes, shoulder problems are the second or third most common complaint only behind low back pain and knee pain that present in primary care 2-3. Shoulder dysfunction due to pain, stiffness, or weakness can cause disability and affect a person's ability to carry out activities of daily living, such as eating, personal hygiene and work. Shoulder pain and disability have a prevalence rate reported from 4.7% - 46.7% across age groups. 4
Four of the most prevalent causes for shoulder pain and disability in primary care are rotator cuff disorders, glenohumeral disorders, acromoclavicular joint disease and referred neck pain. 5 The most common cause of shoulder pain is considered to be subacromial impingement syndrome (SIS) accounting for 44%-60% of all shoulder pain seen in primary care.6 Studies of shoulder disorders demonstrate that symptoms and disability often persist in spite of conservative treatment.7 Many studies questioned the ability of clinicians to diagnose the pathology involved in shoulder problems properly, especially in patients that present with severe pain, chronic complaints or bilateral shoulder involvement. 4, 8-16. There is a small amount of research providing evidence to guide treatment of this patients presenting with shoulder complaints in spite of the risk of disability associated with shoulder pain,.4
The lack of agreement in diagnosing shoulder disorders may be related to the complexity of the factors influencing shoulder function. Difficulty may also arise as the location of symptoms may not always corresponded to the tissue causing the pain since there is convergence of afferent signals from many structures.6 For instance, “pain in the deltoid may be caused by a rotator cuff problem, frozen shoulder, cervical radiculopathy, cervicogenic pain, trigger points, arthritis along with numerous other conditions.”13 It has been suggested that shoulder pain is potentially referred from a variety of musculoskeletal sources, including the shoulder complex, the cervical spine, and the elbow. Pain that is referred from the cervical spine is considered cervicogenic pain. It can include headaches, dizziness, shoulder pain,