Resistance in therapy of the functional shoulder impingement syndrome—Pathogenesis and possibilities of treatment in complementary medicine

Abstract

Background The impingement syndrome of the shoulder is the most common pain syndrome of the upper extremities. The sensomotoric disorder and triggerpoints of muscles realizing shoulder/scapula movement play an important role in the pathogenesis of this disease. To normalize the dysfunction of these muscles is difficult and often frustrated and so a number of patients get renewed shoulder pain after the first or second orthopaedic treatment. Finally operative intervention/surgery is the further way of therapy. Question What is the reason of the resistant muscle/shoulder dysfunction? Is the overloading of muscles the only reason or is there a connection with disturbance of inner organs? Methods From 2004 to 2008 we examined 286 pretreated (pain therapy/physiotherapy) patients with resistant shoulder impingement syndrome. We carried out surface elektromyography (SEMG) of the following muscles: m. trapecius-pars descendens, m. infraspinatus, m. serratus ant., m. latissimus dorsi, m. trapecius-pars ascendens. These muscles are important not only in a regular movement of the shoulder but also in reflex zones because of diseases of inner organs. Furthermore we did clinical/osteopathic exam especially of the shoulder (constant score), spine and the abdomen, looked for muscle trigger points, and, if necessary, conducted a lab exam (biochemistry). Results We observed in all patients segmental dysfunction of the cervical/thoracic/lumbar spine, the pelvis and the scapula function of the diseased side. In SEMG all patients showed hyperacticity of the m. infraspinatus, m. latissimus dorsi in anteversion/scaption/abduction/internal rotation movement of the diseased shoulder. In 130 patients with shoulder pain on the right side, we found liver and/or gall bladder dysfunction per osteopathic exam of the abdomen and in the former case history. Ninety-six patients with shoulder pain on the left side showed problems with the stomach and/or pancreas. Here, further exams (gastroduodenskopy, sonography, lab, a.s.o.) were necessary in 82 patients. After a 6-week “4-step-therapy” (osthepatic treatment of the spine/pelvis/shoulder/abdomen, special injection techniques-“neuraltherapie”, treatment of the affected inner organs, special physiotherapy including SEMG feedback therapy) 253 from 286 patients had no pain, a normal range of motion of the diseased shoulder and an excellent muscle function. Conclusion The SEMG is a qualified method to verify hyper-/hypoactivities of the muscles in shoulder pain. It could also be used in controlling therapy effects or in feedback therapy. Segmental dysfunction of the spine/pelvis and the dysfunction of the scapula are very important in chronic shoulder pain. Without a regulation of these disturbances a normal shoulder function is not possible. Dysfuntion and triggerpoints of shoulder/scapula muscles could be initiated by diseases of liver, gall bladder, stomach or pancreas, which means that a complex treatment is necessary for successful therapy of the chronic functional impingement of the shoulder, which especially includes a treatment and normalizing of the affected inner organs.