2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research

Viscerally Associated Shoulder Pain
Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of View
Viscerally Associated Shoulder Pain
Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of
View
Shoulder pain has been reported to be a frequent motif of consultation of both
therapists and doctors with a tendency to increase in industrial countries. According
to the Austrian health survey 2006/2007, 6.2% (428.100) of the population indicated
having had pain in the shoulders within the last 12 months, the prevalence increasing
with age (Statistik Austria, 2007).
The examination and evaluation of the shoulder and neck area count among the
most demanding tasks for a therapist. A thorough structural diagnosis and evaluation
of the possible causes is of utmost importance, the area connecting different parts of
the spine and the extremities. Therefore, good clinical knowledge about the
mechanisms involved in lesions of the shoulder area is an essential condition for the
general understanding of shoulder pain and dysfunctions in the shoulder joint
(cf. Diemer/Sutor 2010).
Besides degenerative disorders of the shoulder joint itself, disorders affect the
muscles, tendons and the bursa of the shoulder joint. These dysfunctions include the
rupture of the rotator cuff, tendinitis calcarea, frozen shoulder and impingement
syndrome (cf. Ehmer 2003). The impingement syndrome alone caused by a
mechanical compression of the rotator cuff, the subacromial bursa and the long
biceps tendon against the anterior surface of the acromion counts for 44 – 65% of all
complaints in the shoulder area seen in a medical practice (cf. McClure et al. 2006).
Among the risk factors for the onset of shoulder pathologies currently discussed are
the narrowing of the subacromial gliding space, the shortening in the acromiohumeral
distance during shoulder elevation, the abnormal position and movement of
the scapula and the change in the correlation of the different muscles (cf. Hèbert et
al. 2002; Gansen/Irlenbusch 2002).
Since the problem-causing factor and the painful structure are located in different
areas, a precise examination is often difficult but also highly relevant. If the reasons
for the shoulder pain cannot be found, the treatment generally concentrates on the
symptom, often resulting in an unsatisfactory treatment outcome. If the pain
experienced by the patient cannot be reproduced by shoulder movements and tests,
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