MEDICAL MASSAGE vs. SEVERE NECK AND SHOULDER DYSFUNCTION

          We hope that all our readers will greatly enjoy and appreciate this clinical case submitted by Sandra Abbott, LMT, CMMP, a recent graduate of SOMI’s Medical Massage Certification Program.

          All of our former students develop advanced clinical skills and expertise that allow them to help patients with a wide array of complex somatic abnormalities. Pay attention to a profound understanding of clinical evaluation and how skillfully Sandra develops a treatment strategy, adding new modalities when the time is right, and slowly builds up clinical response. However, there is another aspect of this Case of the Month which stands out: Sandra went the extra mile—again and again—to get to the root cause of her patient’s dysfunction.

          She is a medical massage therapist, not a radiologist, and at first glance, she was unable to fully process the complex clinical terminology physicians use to communicate diagnostic findings. Nevertheless, her professional curiosity and methodical research allowed her to decode the radiologist’s report, understand the cascade of pathological events in the patient’s shoulder, and develop a highly effective treatment strategy.

          This is what we at SOMI call true dedication to the profession and to patients. Thank you, Sandra, for putting SOMI’s training to work and helping a patient in great need.

Dr. Ross Turchaninov
Editor-in-Chief

MEDICAL MASSAGE vs. SEVERE NECK AND SHOULDER DYSFUNCTION

  By Sandra Abbott, LMT, CMMP

Lake Panasoffkee, FL

PATIENT PROFILE

          My patient is a 90-year-old retired construction worker who continues to work as an entrepreneur, performing full home reconstructions.

COMPLAINTS

          I first saw the patient in May 2025. His primary complaints included:

• Pain in the neck and both shoulders, especially the right shoulder
• Significant restriction in the right shoulder range of motion (ROM), interfering with construction work
• Grinding sensations in both shoulders during active movement
• Pain radiating from the shoulder to the elbow at times
• Pins-and-needles sensation and periodic numbness in the right thumb and index finger
• Periodic numbness of the third and fourth fingers of the left hand during sleep

          Initially, I provided a few Therapeutic Massage sessions, but it quickly became clear that his condition was far more complex. I proposed switching to Medical Massage protocols, and the patient agreed. I began with a comprehensive Clinical Interview, as taught by SOMI.

CLINICAL INTERVIEW 

          The patient reported three significant traumatic events:

1. A serious motorcycle accident involving head, neck, right shoulder, and arm impact
2. A work-related accident affecting the left arm and shoulder
3. A recent rear-end motor vehicle collision, which prompted him to seek my care

          During the most recent accident, his vehicle was struck from the back passenger side, causing his left shoulder to impact the door. This resulted in a torsional rotation of the torso and hips to the left.

           Following the accident, X-rays and MRI of the cervical and lumbar spine were performed. No fractures were identified; however, the cervical MRI revealed:

• Cervical spondylosis
• Secondary foraminal stenosis at levels C4–C5, C5–C6, C6–C7, and C7–T1

           Before this accident, the patient had been relatively pain-free. However, due to advanced age, his brain appeared to activate multiple compensatory mechanisms, reawakening symptoms related to prior injuries.

          His primary care physician recommended physical therapy, but the patient discontinued treatment after several sessions because his symptoms worsened. Massage therapy provided by the therapist brought only temporary relief.

CLINICAL EVALUATION

Visual Observation

• Shoulder movements were rigid
• Normal arm swings during gait were absent
• Cervical flexion was limited (chin could not touch upper chest)
• Cervical rotation to the right was restricted

Testing

• All shoulder ROM—flexion, extension, abduction, internal and external rotation—was severely restricted.
• Abnormal scapulohumeral rhythm was present, with the scapula moving synchronously with the humerus.
• Numbness in the right thumb and index finger suggested radial nerve irritation.
• Numbness in the third and fourth fingers of the left hand suggested median nerve irritation.

          A Sensory Test confirmed sensory deficits at the terminal distribution of the radial nerve on the right and the median nerve on the left.

          Next, I applied Dr. Wartenberg’s Test to assess whether tension in the Anterior Scalene Muscles (ASMs) was irritating the brachial plexus. The test was positive bilaterally.

          The brachial plexus is formed by spinal nerves C5–T1, which give rise to all peripheral nerves supplying the upper extremity. The ASMs themselves are innervated by C3–C8, and their tension was likely secondary to cervical trauma from multiple accidents and work-related injuries.

          To assess cutaneous reflex zones, I used Dr. Kibler’s Technique #1:

• Skin folds were extremely thick, indicating fluid retention within the dermis

          To evaluate the superficial fascia (second level of connective tissue zones), I applied Dr. Kibler’s Technique #2.

• Skin mobility was severely restricted due to adhesions between the skin and superficial fascia
• Fascial densification and scarification were evident
•  

Shoulder MRI Analysis

          Because shoulder pain and ROM restriction were the patient’s primary complaints, his physician ordered an MRI of the right shoulder. I requested the radiologist’s report. Although the MRI’s findings were initially difficult to interpret, I conducted extensive research to decode them and develop an appropriate treatment protocol. Here are MRI Findings with my interpretation in italic:

1. Severe glenohumeral osteoarthritis with undersurface spurs
   (Bone spurs form as the body attempts to repair cartilage degeneration.)
2. Type III acromion
   (A “hooked” acromion that narrows the subacromial space and increases rotator cuff impingement.)
3. Full-thickness rotator cuff tear (1–2 mm) involving the supraspinatus and infraspinatus
   (Complete disruption of tendinous parts of both muscles with no retraction, indicating a relatively recent injury. However, two major players of the rotator cuff are now in full dysfunction. It means that the deltoid muscle gives extra support for the shoulder function.
4. Subacromial and subdeltoid bursitis
   (Post-traumatic inflammation with excess synovial fluid production.)
5. Moderate atrophy and fatty infiltration of teres minor and mild infraspinatus atrophy
   (Muscle degeneration due to prolonged functional loss. Healthy myofibrils are replaced by fatty tissue.
6. Degenerative labral tear
   (Labral damage compromised joint stability.)
7. Partial tear of the long head of the biceps tendon
   (Posttraumatic biceps tendinitis may impair shoulder flexion.)

Shoulder Testing

Hawkins Test was positive

• Severe limitation of flexion (<90° vs. normal 180°)
• Inability to extend the arm to reach the back pocket
• Restricted abduction and internal/external rotation

TREATMENT

          Given the patient’s pain and occupational limitations, treatment focused first on restoring shoulder function.

Initial Phase (Biweekly, 60-minute sessions)

1. Therapeutic massage and lymph drainage (15 minutes)
2. Connective tissue massage for the posterior neck, shoulders and middle back to eliminate reflex zones in the dermis and superficial fascia
3. Paravertebral muscle relaxation techniques (Big Fold, General Technique)
4. Therapeutic massage and drainage

          Results: Improved tissue mobility, reduced pain, and increased soft tissue elasticity in the posterior neck, upper shoulders, and middle back.

Intermediate Phase

          Due to the sensory deficit and positive Wartenberg’s Test, I added the ASM Protocol.

1. Drainage and techniques of paravertebral muscles relaxation and decompression of deep fascia
2. Spiral friction
3. ASM Syndrome Medical Massage Protocol
4. Lymph drainage

Results: Wartenberg’s Test became negative, and brachial plexus irritation resolved.

Shoulder-Specific Phase

1. ASM Medical Massage protocol
2. Pectoralis Minor Medical Massage protocol to decompress part of the brachial plexus on the anterior shoulder and decrease tension in the very thigh pectorals
3. Lymph drainage
4. Full Rotator Cuff Medical Massage Protocol to address each component of the rotator cuff separately:

• Drainage
• Align friction and Dr. Sirasini’s circular friction,
• Fixed true vibration and tuning fork in the areas of active trigger points
• Trigger Point Therapy
• Post-isometric relaxation for each muscle of the rotator cuff and the biceps

          Results: A major breakthrough occurred with the successful release of the subscapularis, despite technical difficulty.

TREATMENT OUTCOMES

• Pain eliminated
• Sensory deficits resolved
• ROM in the shoulder restored, active shoulder flexion restored to 170° (from <90°)
• Full cervical flexion was regained
• Functional use of the upper extremities was regained

FINAL WORDS

          Comprehensive clinical evaluation, individualized treatment planning, and precise execution can feel overwhelming at the beginning of a Medical Massage Practitioner’s journey. However, SOMI’s rigorous clinical training provided me with ALL the tools and confidence to help patients in truly desperate situations.

          I am deeply motivated to continue growing as a medical massage practitioner and to meet future clinical challenges. Medical Massage is a fascinating part of the massage therapy profession!

ABOUT THE AUTHOR

Tags: 2025 Issue #3