2 Der viszeral assoziierte Schulterschmerz - Osteopathic Research

Viscerally Associated Shoulder Pain
Subjective Perspectives and Diagnostic Procedures – the Osteopathic Point of View
tensegrity model (cf. Myers 2010; Dräger et al. 2011; Ciranna-Raab 2010; Oschman
2009; Schwind 2003), the presentation of the continuity of the fascial system (cf.
Myers 2010; Schwind 2010; Paoletti 2001) and the possible transmission of fascial
tension (cf. Finet/Williame 2000; Richter/Hebgen 2007; Hebgen 2008; Barral 2005;
Helsmoortel et al. 2002), the fascial system is mentioned by six interview partners as
a possible cause for the viscerally associated shoulder pain.
Another possible explanation strategy is the convergence of somatic and visceral
afferents (3 nominations) and the referred pain via a direct pressure on the phrenic
nerve (3 nominations). These last two explanations for a possible referral of pain are
also mentioned in the specialized medical literature (cf. Trepel 2008; Speckmann et
al. 2008; Schünke et al. 2006). None of the interview partners considered the third
explanation model, the pain referral based on the embryological development (cf.
Goodman/Snyder 2007; Wancura-Kampik 2010).
The category relating to the importance of organic factors in shoulder joint
dysfunctions showed a high level of agreement. All seven interview partners
recognize a possible influence of organs in the shoulder area. The relationship
between the visceral and the parietal system is also reflected in the osteopathic
literature (Barral 2005; Hebgen 2008; Richter/Hebgen 2007; Liem et al. 2005;
Kwakman 2005; Helsmoortel et al. 2002). Percentage-wise, one osteopath considers
the influence of an organ dysfunction on the shoulder area to be 20%, two consider it
to be 50% and another two up to 70%.
Diemer/Sutor (2010) are highly critical of the influence of organs on the shoulder
area. The authors describe that 66% of patients with a heart attack report pain in the
shoulder and the arm. This should not lead automatically to the conclusion that
numerous types of shoulder pain are of visceral origin. An inadequate and
insufficiently comprehensive examination may lead to overseeing a shoulder
problem.
In the context of the interviews, five osteopaths indicate that after the examination
one can never be sure whether an organ is the cause for a shoulder joint dysfunction.
Therefore, the relationship is established retrospectively after a successful therapy.
Success meaning that the patient feels better after a treatment or a series of
therapies. Since visceral treatment is also a very good pain therapy (cf. Diemer/Sutor
2010), one has to ask whether this conclusion is automatically valid and whether the
cause of shoulder pain is too often and too promptly located in the visceral area.
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