By: Wayne Henry Zemelka, DC
A ‘High Shoulder’ is easily detected by comparing one shoulder with the other, especially in the standing position (Fig. 1). Keep in mind that previous injury or broken bones may be considered contraindications when conducting your examination. With palpation you will find a tender nodule or trigger point at the second intercostal space, where a portion of the pectoralis major muscle is located. This will be approximately two inches lateral from the sternal attachment of the ribs. This is by no means the only trigger point you will find. When the trigger points of the second rib are found there may be additional points of tenderness at the sternal, 4th and 5th rib and at the level of the zyphoid at the 6th rib.
When the left shoulder is involved pain may be present down the inner aspect of the left arm. Tenderness and sensitivity may be present in the breast area causing hyper-sensitivity to the nipple, in both the male and female patients. The patient may complain that the rubbing of garments produces this sensitivity.
The patient will have difficulty in raising the arms, especially in attempts to do such menial tasks as combing the hair, touching the head, and reaching above the head to turn on a light. Associated considerations may include rotator cuff involvement, the possibility of pain at the bicipital groove on the ‘High Shoulder’ side, and difficulty reaching behind the back.
In many situations such as this some may use the term ‘frozen shoulder,’ which in the medical model would involve surgery to remove tissue or bone—or both. This would be the extreme case in attempting a solution for the high shoulder that sometimes gets the label of ‘frozen shoulder.’
In the Chiropractic model, we look at the structural relationships of the rib cage and the muscular contractions that create this problem. Also, consideration must be given to what the patient may be doing to exacerbate the problem. Carrying a shoulder bag or backpack over one side or the other is the most common cause of this problem. If this is the case they must cease such activities in order to restore muscle integrity and be given an exercise program such as the THERA-CISER® (Fig. 2) and BACKSYS® (Fig. 3) systems from Foot Levelers, Inc. Exercise instructions come with each system.
The Doctor stands on the side of the high shoulder and using the thumb web contact, places the flat of the hand on the upper rib cage. The other hand is placed on the lower portion of the rib cage on the opposite side. Make sure to be on top of the rib cage, not under the ribs on the opposite side of the high shoulder (Fig. 4).
Thrusting is horizontal, not down toward the floor (Fig. 5). This is why you must use a Segmental Drop Table to accomplish this adjustment. Do not use this style of adjustment on anything but a drop table. Set the Dorsal and Lumbar drops to the weight of the patient so that it takes just a light thrust to drop the pieces. The thrust is horizontal with the high side toward the feet and upwards on the opposite side to the top of the table. Three to four thrusts are sufficient to accomplish this move on a drop table.
After proper adjustment there will be a decrease in the trigger points of the second intercostal space, and of course a change in the elevation of the rib cage. The patient will also note it is easier to breathe.
The adjustment of the Elevated Rib Cage or High Shoulder can solve many of the problems associated with the rib cage. When the rib cage is constricted by muscle spasm and structural distortion the affects may produce any number of symptoms affecting the human race. This may include cardiac arrhythmia, bronchitis, lung problems, and stomach disorders. This is just a few of the complaints heard from patients.
One of the primary problems that may result from the lack of expansion of the rib cage is Oxygen Deficiency Syndrome. Since oxygen is a primary component of metabolism this has a direct relationship with a decrease in the body’s capability to function in a state of homeostasis. We adjust the dorsal vertebrae, so why not complete the adjustive process and include the rib cage as well?
In future articles we will cover the Posterior and Anterior Rib mobilization adjustment procedures that improve the motion of the overall rib cage.
It is best to take a complete history and rule out the move if there is evidence of osteoporosis, history of surgery, especially open heart procedures, and implants in the chest cavity such as a pacemaker, or the use of wire to bind the rib cage as in an open heart operation.
About the Author
Dr. Wayne Henry Zemelka is a 1975 graduate of Palmer College of Chiropractic. He is certified in Thompson Technique. Dr. Zemelka was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department.