2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research
2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research 2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research
Viscerally Associated Shoulder Pain Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of View examination as well as the medical examination. According to the question guiding the research, the present master thesis concentrates on the diagnostic procedures, which indicate possible causes for shoulder pain and specifically viscerally associated shoulder pain. At the beginning of the consultation, the case history is a discussion with the patient, which serves to collect relevant information on the existing complaints and to evaluate the general condition of the patient. During the case history taking detailed questions on the organ system already allow to determine a possible relationship between the shoulder joint dysfunction and an organ dysfunction. Therefore it is essential to ask questions about possible disorders in individual organs since the patient may not have recognized the disease or related it to an organ dysfunction (cf. Croibier 2006; Hinkelthein/Zalpour 2006; Mayer-Fally 2007). If, for example, a patient presents with symptoms like a non restorative sleep, digestive problems related to the female hormonal cycle, sleep disorders including waking up soaked with perspiration between one and three o’clock in the morning, this might be an indication for a liver dysfunction (cf. Hebgen 2008). The global osteopathic examination, which includes the observation, the global listening test standing, sitting and lying, the local listening tests for the abdomen, fascial tension tests for the extremities as well as tests for the spine and the respiration, serves to get a comprehensive picture of the lesion pattern (cf. Fossum 2010). Concerning the viscerally associated shoulder pain, the observation also includes the postural examination, which may serve as an important indicator for chronic disease, since pain and recurrent dysfunctions often provoke changes in posture (cf. Hebgen 2008). Areas with higher tension are a clear indicator for the localisation of the disorder, sometimes they even show the level – parietal, visceral or cranio-sacral – as well as where the treatment should be started from (cf. Fossum 2010). Both the general listening and the local listening use modifications in the tension of the body’s fascia as a localisation diagnosis, since in dysfunction the equilibrium of the tissues of the whole body is affected, the tissues being drawn to the side of the 139 | S e i t e
Viscerally Associated Shoulder Pain Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of View fixation. In the same way, the Sotto-Hall test allows to detect continuous fascial drag, which may trigger shoulder pain (cf. Hinkelthein/Zalpour 2006; cf. Croibier 2006). Inhibition is another osteopathic examination tool, which uses pressure on the soft tissue to relax the tissues, thereby interrupting momentarily the lesion chain. If, for example, the symptoms of a patient change when lifting the organ or if the arm is slightly elevated during inhibition, a relationship between the dysfunction of the organ and the shoulder joint may be established (cf. Croibier 2006). To evaluate the organ movement, which is an expression of the organ function, the visceral osteopathic diagnosis should also include both mobility and motility tests on the organ. If an organ loses its capacity to move partially or completely, for example because of adhesions or a ptosis, a dysfunction on the visceral level can be suspected (cf. Hebgen 2008). The assessment of the cranio-sacral system is yet another starting point for the diagnosis and consequently for the treatment. The therapist palpates for symmetry, frequency, amplitude and force of the rhythmical movements in the cranium, the sacrum or other tissues of the body, since any dysfunction in the organism reveals itself through a change in the symmetry and the other qualities of the cranio-sacral rhythm. Therefore, the cranial rhythm is also used to diagnose organ dysfunctions, since it helps to localize and consequently treat any dysfunction or disorder in the patient’s organism (cf. Liem 2001). In the local osteopathic examination, specific active and passive tests and examination procedures are used to further test the joints and structures both qualitatively and quantitatively which already indicated some dysfunction during the global assessment procedure (cf. Fossum 2010). The passive examination evaluates the quantity of the joint play. Furthermore, it allows to evaluate the quality of the movement, the elasticity and/or flexibility of a joint, both very important aspects since the quality of the end feel may serve as a clue to the cause of the dysfunction. For example, a hard, non-elastic end feel with a sudden stop may be related to a bony degenerative change, whereas an early progressive resistance with an elastic end feel is more likely to indicate a hypertonic muscle or a myofascial shortening (cf. Fossum 2010). Since fascia form a whole body network (cf. Myers 2010), musculoskeletal symptoms may appear in an area far away from the real cause. An organ dysfunction may reveal itself through hypertonicity of one or several muscles in the shoulder girdle, which, in turn, would considerably disturb the biomechanics of the 140 | S e i t e
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- Seite 127 und 128: Literaturverzeichnis Literaturverze
- Seite 129 und 130: Literaturverzeichnis Giamberardino
- Seite 131 und 132: Literaturverzeichnis Mayer-Fally E.
- Seite 133 und 134: Literaturverzeichnis Schwind P. (20
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- Seite 137 und 138: Anhang Anhang Interviewleitfaden Ei
- Seite 139 und 140: Anhang 2.3 Zusammenhang Organ - Sch
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Viscerally Associated Shoulder Pain<br />
Subjective Perspectives and Diagnostic Procedures – the <strong>Osteopathic</strong> Point of View<br />
examination as well as the medical examination. According to the question guiding<br />
the research, the present master thesis concentrates on the diagnostic procedures,<br />
which indicate possible causes for shoulder pain and specifically viscerally<br />
associated shoulder pain.<br />
At the beginning of the consultation, the case history is a discussion with the patient,<br />
which serves to collect relevant information on the existing complaints and to<br />
evaluate the general condition of the patient. During the case history taking detailed<br />
questions on the organ system already allow to determine a possible relationship<br />
between the shoulder joint dysfunction and an organ dysfunction. Therefore it is<br />
essential to ask questions about possible disorders in individual organs since the<br />
patient may not have recognized the disease or related it to an organ dysfunction (cf.<br />
Croibier 2006; Hinkelthein/Zalpour 2006; Mayer-Fally 2007). If, for example, a patient<br />
presents with symptoms like a non restorative sleep, digestive problems related to<br />
the female hormonal cycle, sleep disorders including waking up soaked with<br />
perspiration between one and three o’clock in the morning, this might be an<br />
indication for a liver dysfunction (cf. Hebgen 2008).<br />
The global osteopathic examination, which includes the observation, the global<br />
listening test standing, sitting and lying, the local listening tests for the abdomen,<br />
fascial tension tests for the extremities as well as tests for the spine and the<br />
respiration, serves to get a comprehensive picture of the lesion pattern (cf. Fossum<br />
2010).<br />
Concerning the viscerally associated shoulder pain, the observation also includes the<br />
postural examination, which may serve as an important indicator for chronic disease,<br />
since pain and recurrent dysfunctions often provoke changes in posture (cf. Hebgen<br />
2008). Areas with higher tension are a clear indicator for the localisation of the<br />
disorder, sometimes they even show the level – parietal, visceral or cranio-sacral –<br />
as well as where the treatment should be started from (cf. Fossum 2010).<br />
Both the general listening and the local listening use modifications in the tension of<br />
the body’s fascia as a localisation diagnosis, since in dysfunction the equilibrium of<br />
the tissues of the whole body is affected, the tissues being drawn to the side of the<br />
139 | S e i t e
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