2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research

Viscerally Associated Shoulder Pain
Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of View
In the framework of the osteopathic evaluation process to identify visceral symptoms,
it could be demonstrated that the case history was an important element for all seven
interview partners and that all interview partners ask questions related to possible
organic diseases. The high importance attributed to the case history is consistent
with the results of the master thesis of Stemeseder (2007). Only three interview
partners also explicitly explore the mechanism of onset and conduct a pain analysis.
This last aspect does not follow the recommendations in the osteopathic
(Hinkelthein/Zalpour 2006; Croibier 2006; Mayer-Fally 2007; Hebgen 2008) and
medical literature (cf. Diemer/Sutor 2010).
Four interview partners include observation in their diagnostic process. This result is
consistent with the results of the study done by Krönke (2006) but not with the study
of Biberschick (2010) in which 100% of all interview partners include observation. It
has to be stressed that only one interview partner draws detailed conclusions on a
possible organ dysfunction as indicated by postural changes. This aspect is not
consistent with the observations and comments in the osteopathic literature that
clearly indicates that when observing his/her patient the therapist pays attention to
diagnostic zones and dysfunctional organs (cf. Croibier 2006; Mayer-Fally 2007;
Hinkelthein/Zalpour 2006; Hebgen 2008; Fossum 2010).
The global osteopathic examination showed that the listening is of particular
relevance in the osteopathic diagnostic process. Six interview partners consider this
myofascial test as particularly important when recognizing visceral problems in
relation with shoulder joint dysfunctions. This high importance is consistent with the
findings in the study done by Krönke (2006) and Biberschick (2010).
Concerning the myofascial tests, four interview partners use inhibition, two use the
Sotto-Hall test during their osteopathic diagnostic process. The frequency of use of
the Sotto-Hall test is also reflected in the study done by Stemeseder (2007). When
asked why they did not use this test, four interview partners explicitly mentioned the
questionable reliability and validity of this test. This aspect is even more interesting if
one considers the fact that the interview partners did not demonstrate the same
reservation regarding the reliability and the validity of the global listening. With
reference to this last point, it has to be stated that a study on the intra-rater and interrater
reliability (Rittler 2010) of the initial position in standing only revealed a chance
agreement and that the qualitative criterion for the reliability of the listening test on
the abdomen was not met (Podlesnic 2006).
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