Integrated Management of Periarthritis Shoulder with Trapezius Stiffness: A Case Report

Abstract

Periarthritis shoulder is a common musculoskeletal condition characterized by pain, stiffness and restriction of shoulder movements, which may significantly interfere with activities of daily living. Associated myofascial trigger points and trapezius muscle stiffness can further contribute to pain and functional limitation.

This case report presents a 34-year-old female who presented with neck pain, shoulder pain associated with restricted movement, and trapezius trigger-point pain. Clinical examination led to a provisional diagnosis of periarthritis shoulder with trapezius stiffness. The patient was managed at Shri Sivalaya Holistic Natural Healing Hospital using an integrated therapeutic approach comprising manipulation, trigger-point release, interferential therapy (IFT), laser therapy, shortwave diathermy therapy, exercise therapy and massage therapy.

The multimodal approach was directed towards reducing pain, relieving muscular stiffness, improving shoulder mobility and restoring functional movement. The patient's clinical progress was assessed during the course of treatment.

Introduction

Periarthritis shoulder, commonly referred to as frozen shoulder, is characterized by pain and progressive restriction of shoulder movement. The condition can significantly affect upper-limb function and activities of daily living.

Myofascial trigger points involving the trapezius muscle may coexist with shoulder disorders and contribute to localized pain, muscle stiffness and restricted neck and shoulder movements.

Management of shoulder disorders may involve a combination of physical and rehabilitative interventions. An individualized multimodal approach can be used to address pain, muscular stiffness, soft-tissue dysfunction and restricted movement.

This case report describes the management of a patient with clinical features suggestive of periarthritis shoulder associated with trapezius trigger-point stiffness using an integrated treatment protocol.

Case Presentation

Patient Profile

A 34-year-old female presented to Shri Sivalaya Holistic Natural Healing Hospital with complaints of:

• Neck pain
• Shoulder pain with restricted movement
• Trapezius trigger-point pain

The patient was evaluated through detailed history and physical examination.

Medical History

There was no documented history of diabetes mellitus, hypertension, chronic obstructive pulmonary disease or hypothyroidism.

Surgical History

No significant surgical history was reported.

Family History

Family history of coronary artery disease was documented.

Personal History

The patient followed a vegetarian diet. No smoking or alcohol use was documented.

Appetite was recorded as good. Sleep was documented as disturbed. Micturition was normal and bowel habits were regular.

General Examination

The recorded clinical parameters were:

Parameter
Age - 34 years
Sex -Female
Pulse - 93/min
Blood pressure - 112/78 mmHg
SpO₂ - 99%
Height -154 cm
Weight - 69 kg
BMI -29.1 kg/m²

No significant abnormality was documented on general systemic examination.

Clinical Examination

The patient presented with neck and shoulder pain accompanied by restricted shoulder movement. Local examination revealed pain and tenderness associated with the trapezius region, including clinically identifiable trigger points.

Based on the presenting symptoms and clinical findings, the provisional diagnosis was:

1. Periarthritis shoulder
2. Trapezius stiffness with trigger-point pain

Therapeutic Intervention

The patient received a multimodal treatment programme at Shri Sivalaya Holistic Natural Healing Hospital.

1. Manipulation Therapy

Appropriate manual manipulation techniques were administered with the objective of improving joint mobility and reducing mechanical restriction.

1. Trigger-Point Release

Trigger-point release was performed over the affected trapezius musculature to reduce localized tenderness and muscular tension.

1. Interferential Therapy (IFT)

IFT was administered as part of the pain-management protocol with the aim of reducing pain and facilitating rehabilitation.

1. Laser Therapy

Laser therapy was incorporated as a supportive modality for management of pain and local soft-tissue dysfunction.

1. Shortwave Diathermy Therapy

Shortwave diathermy therapy was administered as part of the multimodal management approach to address localized musculoskeletal pain and soft-tissue dysfunction.

1. Exercise Therapy

A therapeutic exercise programme was prescribed to progressively improve shoulder mobility, muscular flexibility, strength and functional movement.

1. Massage Therapy

Massage therapy was provided to the affected neck and shoulder musculature with particular attention to the trapezius region, with the objective of reducing muscle tension and improving soft-tissue mobility.

Treatment Rationale

The treatment protocol was designed as a multimodal approach addressing different components of the patient's presentation:

Pain management → muscular relaxation → trigger-point release → improvement in mobility → progressive exercise → functional recovery

The combination of manual therapy, electrotherapy, laser therapy, shockwave therapy, massage and therapeutic exercise allowed the treatment programme to address both pain and functional restriction.

Clinical Outcome

At the time of admission, the patient presented with significant restriction of shoulder range of motion associated with pain. The functional limitation was severe enough that she was unable to perform routine activities such as combing her hair. She also experienced pain even at rest.

Following the multimodal therapeutic intervention consisting of manipulation, trigger-point release, IFT, laser therapy, shortwave diathermy, exercise therapy and massage therapy, a clinically significant improvement was observed.

Before and After Clinical Summary

At Admission

• Significant restriction of shoulder range of motion.
• Severe difficulty in performing routine upper-limb activities.
• Unable to comb her hair independently.
• Pain present even at rest.
• Functional activities were considerably affected.

At Discharge

• Significant improvement in shoulder range of motion.
• Able to perform routine daily activities independently.
• Able to comb her hair without difficulty.
• No pain at rest.
• Overall functional ability and comfort were improved.

Discussion

Periarthritis shoulder can result in significant pain and restriction of shoulder movement. Muscular involvement of the trapezius me to the patient's overall symptom burden, particularly when associated with myofascial trigger points.

In this case, the patient presented with a combination of neck pain, shoulder pain with restricted movement and trapezius trigger-point pain. A multimodal rehabilitation approach was therefore adopted.

Manipulation and trigger-point release were used to address mechanical restriction and localized muscular dysfunction. IFT, laser and shockwave therapy were incorporated as physical modalities for pain and soft-tissue management. Massage therapy was used to address muscular tension, while exercise therapy focused on restoration of shoulder mobility and functional capacity.

The combination of these interventions provided an integrated approach rather than relying on a single therapeutic modality.

Conclusion

This case highlights the use of an integrated multimodal therapeutic approach in a 34-year-old female presenting with periarthritis shoulder and associated trapezius stiffness with trigger-point pain.

The treatment programme consisted of manipulation, trigger-point release, IFT, laser therapy, shortwave diathermy therapy, exercise therapy and massage therapy, with the overall objectives of reducing pain, relieving muscular stiffness and improving shoulder mobility and function.