The AAO Journal, 2023/06, 33(2):23. doi: 10.53702/2375-5717-33.2.20, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

case report [736]
female [654]
hemiparesis [2]
OMT [3924]
osteopathic manipulative treatment [3945]
shoulder [135]
women [607]

Abstract:

Introduction/Background: An arteriovenous malformation (AVM) rupture is rare, occurring in less than 1% of the population according to Mayo Clinic. The resulting brain hemorrhage can lead to unilateral muscle weakness called hemiparesis. This weakness leads to increased risk of musculoskeletal injuries, specifically of the shoulder joint due to its inherent instability. Case: A 20-year-old female presented to the Osteopathic Manipulative Treatment (OMT) clinic 18-months following AVM rupture. Shoulder weakness from left sided hemiparesis caused supraspinatus tendinosis and subdeltoid bursitis diagnosed via MRI 16-months following hemorrhage. Bicep tendonitis was also suspected due to positive Yergasons and Speeds tests on osteopathic structural exam. The patient exhibited decreased range of motion (ROM) in left shoulder abduction and flexion, and complained of numbness and tingling into her fingertips. She also noted sharp shoulder pain radiating to her elbow at rest and with motion. The OMT protocol included decreasing hypertonicity of the upper extremity muscles through counterstrain, increasing ROM with Spencer’s articulatory technique, and treating the thoracic spine with muscle energy and soft tissue to prevent future compensation through the shoulder. Results: The patient had a total of 13, 60-minute treatments spanning 1 year. After 3 treatments spanning 2 months, she had a negative Yergasons test, and after 11 treatments spanning 7 months, she had a negative Speeds test. After 12 treatments she denied any shoulder pain at rest and decreased pain with abduction and flexion. She also denied numbness and tingling. Discussion: Hemiparesis increases risk of musculoskeletal injury, specifically that of the shoulder. OMT was shown to increase ROM, and reduce shoulder pain, numbness and tingling. Study limitations include basing outcome on one patient, however promising results should generate additional studies.