Clinician: Salvato Francesco
A 46-year-old female patient, employed as an office worker, has been regularly practicing Pilates for approximately two years, with a frequency of two sessions per week. She presented to my clinic for a clinical evaluation due to the presence of pain localized to the anterolateral region of the right shoulder, with an onset approximately four months prior. Pain intensity assessed using the NRS scale, ranges from 0/10 to 6/10 and is recurrent in nature. The symptoms occur several hours after activities involving load on the right upper limb, such as household cleaning, carrying grocery bags up to the third floor, and Pilates sessions that include weight-bearing positions on the upper limbs. The patient also reports the onset of nocturnal pain with an NRS score of 4/10.
Two weeks prior to the visit, the patient underwent a musculoskeletal ultrasound examination of the right shoulder, which revealed supraspinatus tendinopathy. No other associated pain is reported. In her remote medical history, she reports an episode of cervical pain (CL / CP3 BI) approximately three years ago, which resolved with physiotherapy and therapeutic exercise. The patient denies any previous trauma or surgical interventions.
Regarding internal medical history, she reports an episode of pneumonia requiring hospitalization approximately 14 years ago and the presence of sinusitis for about two years.
During the clinical evaluation, global motor verification of the upper limb and the cervical spine were performed. As hypothesized on the basis of the medical history, pain and any sensations of discomfort or limitation were not elicitable during the physical examination, as the symptoms manifest several hours after functional loading of the limb.
Based on the collected data, the hypothesis was oriented toward a visceral dysfunction involving the RA (Respiratory Apparatus). Therefore, anterior palpation of TH, LU, and PV was performed in order to identify the most involved catenary. The greatest densifications were found at the levels of AN LA TH RT and AN LA PV RT; therefore, I oriented the assessment toward a possible latero-lateral (LL) catenary, subsequently confirmed by the positivity of AN LA CL RT and AN LA CP3 LT. The treated points were AN LA CA2 BI, AN LA TH RT, AN LA CP3 RT, AN LA CL RT, AN TH LT, and AN LA HU. During the first session, treatment was focused exclusively on the patient’s ventral aspect.
Three days after the session, the patient reported a marked improvement in symptoms, with pain reduction from NRS 6/10 to mild discomfort rated at 2/10 and complete resolution of nocturnal pain. During the subsequent session, verification of any additional anterior points was performed, followed by evaluation and treatment of the associated posterior points.