Massage Therapy Case Study – Adhesive Capsulitis vs. Arthritis

baking_breadEdie was a wonderful home-visit client, and not just because she was always baking. She was also a real therapeutic challenge.

Edie was 93 when I saw her. “I’m having trouble reaching the rolling pin, dear,” she said to me, “my doctor says you might be able to help.” The answer wasn’t long in coming: Edie’s arms were stuck to her sides.

Symphony Of Movement

Lift your arm out to the side. This simple movement – called abduction or elevation – is actually a complex symphony of movements at the glenohumeral joint (arm to shoulder blade), the scapulothoracic junction (shoulder blade to ribcage) and both ends of the clavicle (collarbone). Edie’s problem was a splendid case of adhesive capsulitis, where the glenohumeral joint gets sewn together by overzealous connective tissue. The limitation on her left was about 80%, and on the right was 100%; if she wanted to reach anything above her waist, she had to lean her whole body to the side.

We went to work. We did soft tissue and neuromuscular massage all around her shoulder girdle to the tolerance of a 93-year-old, we did fascial release around the clavicle and scapula, and we did gentle joint mobilizations to work the adhesions loose. Over the course of three sessions we gained ground, giving Edie some increased range.

Hidden Arthritis

Then we hit a wall. “That hurts, but different,” she reported. I assessed, and scratched my head, and then I got it. We had loosened up Edie’s adhesive capsulitis enough to hit her hidden case of arthritis. While the adhesions had kept her shoulder joints limited from within, the cartilage at the edges of her shoulder joints had been quietly withering from lack of use. In effect, her joints had rusted out.

We worked together for a few more sessions. I loosened up Edie’s shoulders to the point where she bumped up against her new pain, and that’s as good as it was going to get. She could reach her rolling pins; the rest of her baking gear she simply moved to the lower shelves. On our last visit she sent me home with cookies, and I left with a new appreciation for the fascinating challenges of age.