A 68 year old patient attended for treatment of a large rotator cuff(supraspinatus) tear of his left shoulder. This gentleman was semi retired, but had done a lot of lifting over time, and now his shoulder pain and movement restriction was affecting his sleep, playing golf, reaching and was even making him feel depressed.
This patients’s Ultrasound scans showed a complete full-thickness tear of the supraspinatus tendon with retracted tendon ends, as well as inflammation of the bursa.
He was advised by his surgeon that surgery would be necessary.
Musculoskeletal assessment revealed an inability to raise(flex or abduct) his left shoulder beyond shoulder height, and specific weakness of external rotation as would be expected. Assessment also revealed diplacement of ribs 8 and 9, a large trigger point in the subscapularis, and secondary trigger points in the left pectoralis, infraspinatus and left gluteus medius.
Treatment of these areas resulted in an immediate improvement of shoulder range to full movement within 2 sessions. Within the next 3 sessions, this gentleman’s reaching, golf game and even his sleeping all improved to the stage where he was able to manage and cope very well. He self reported a 90% improvement in these measures. His mood and outlook all changed, and his wife said that he was even less irritable. He feels now some hope moving forward and he will postpone his surgery as long as possible.
This patient’s pathology would not have changed significantly(perhaps the bursal inflammation may have settled), but other areas of his musculoskeletal system which had become dysfunctional as a result of his pathology had significantly improved allowing his system to work in a more balanced manner. This had improved his outcomes.
This again underlies the importance of evaluating the whole musculoskeletal system and its contribution to any presenting pathology, which is what we do well at NWPG.