Clinician: Sgarminato Massimo
A 59-year-old male patient, an office worker, presented to the outpatient clinic with a three-week history of right shoulder pain associated with a sensation of retrosternal tightness and difficulty swallowing. Pain intensity, assessed using the NRS, ranged from 2–8/10. The patient’s past medical history included well-controlled arterial hypertension treated with beta-blockers, a previous episode of bilateral pneumonia during SARS-CoV-2 infection in 2021, gastroesophageal reflux disease for approximately eight years, diverticulitis in 2015, and appendectomy in childhood. In 2017, he sustained a left knee sprain and a fracture of the left metacarpal following a fall while skiing. The pain was reported to be predominantly nocturnal, independent of posture and also present in the seated position; conversely, the patient reported an improvement in symptoms during walking.
Clinical and functional assessment suggested a dysfunction of the apparatus. Motor verification did not reproduce pain up to 8/10 on the NRS, either during free active movements or against resistance. However, mild tenderness was noted during the execution of complex movements of the right upper limb, such as bringing the hand to the hair or reaching the ipsilateral gluteal region. Swallowing was impossible with the head and neck in full extension and difficult even with minimal cervical extension, with evident compensatory activation of the shoulder girdle. Forced inspiration appeared reduced, with marked accessory recruitment of the sternocleidomastoid and trapezius muscles.
Palpatory verificazion revealed an alteration of the trunk catenary along the latero-lateral (LL) line at the level of the left TH and right LU; the control catenary was altered along the latero-lateral line at the level of the left CL and left CP2 segments. Alterations of the ante-latero CF were also detected at the level of the left SC, HU, and CA, as well as at the level of the right SC and HU. Treatment during the first session focused on the ante-latero CF at the level of LU RT, TH LT, CL LT, CP2 LT, SC BI, and CA LT.
At the end of the session, the patient reported a reduction in the sensation of sternal tightness and an improvement in swallowing function, while right shoulder pain at rest remained unchanged (NRS 2/10). Motor verification showed improved ability to perform complex upper limb movements, which the patient described as smoother and less restricted. In subsequent sessions, completion of the treatment of the anterior points is planned, along with palpatory verification and treatment of the most densified RE LA Fusion Centers.