In this blog I will present the case study of a woman who came to the clinic with some pretty serious issues, including severe pain in her neck, shoulders and thumbs, chronic headaches and insomnia. As this is a complicated case, with various factors at play and various issues to be resolved, I will focus my analysis primarily on the thumbs and hands in keeping with our theme of the past few posts.
Claudia started working with BDK in the Summer of 2010. Her primary concern involved a diagnosis of thoracic outlet syndrome. According to the National Institutes of Health this is “a rare condition that involves pain in the neck and shoulder, numbness and tingling of 
the fingers, and a weak grip.” It is believed to be caused by compression of the blood vessels and nerves as they pass through the narrow space between the clavicle and the upper ribs on their way to the arms.
Claudia was also tested for carpal tunnel syndrome, which was ruled out, along with a more vague diagnosis of “chronic pain syndrome”. Physical therapy was recommended, but when her symptoms did not improve she discontinued treatment. Chiropractic adjustments did not help either. Pain medication was the only thing that eased the pain. She eventually found her way to BDK, however, where we started her on the path to rehabilitation.
During my assessment of Claudia it became clear that a large part of the problem was her 
strenuous work schedule. She worked 50-60 hours a week, mainly sitting at a desk working on the computer. I was immediately struck with her problematic thumb positioning, with the thumbs drawn in and palm closing down. Her shoulders were also drawn up toward her neck and the muscles of the shoulders and the neck were very tight.
It was quite odd for me to learn that the pain in Claudia’s thumbs were considered by other medical practitioners to be symptoms of thoracic outlet syndrome when to me the problem and the solution were clear as day. From my perspective, the problem with her thumbs, hands, arms, shoulders and neck were highly aggravated by her improper ergonomics, compounded by the long work hours and on-going stress over many years. Once we addressed her ergonomics, she quickly began to heal. The thumbs were the easiest piece to resolve.
Once I demonstrated to Claudia the correct and incorrect positions of the thumbs it was as if a light bulb went on for her. She became vigilant in correcting her positioning as well as working daily to stretch the fingers and hands and draw then open. I massaged the affected area and taught her to do self-massage using a wine cork. (In our previous post I included a short video that details this self-massage method. Claudia is now dedicated to taking 15-minute breaks every 2-3 hours and stretching her thumbs, hands, shoulders and neck. She believes these short self-care breaks have been instrumental in relieving her symptoms and allowing her to continue in her line of work.
Here’s my take on how chronic pain conditions develop and how they need to be addressed. There’s often a triggering event, in which a shoulder, for example, is injured. If left unresolved the person will naturally compensate for the pain and disability by changing their position, such as drawing their shoulder up. The typical response to a bodily insult is to contract and constrict the musculature. This action causes a biomechanical imbalance that can then cause a domino of effects.
Add stress and the related muscle tension into the equation and there’s a much greater chance for a chronic condition to develop. In my opinion, Claudia’s thoracic outlet syndrome was the result of such a domino effect. And of course the longer the imbalance exists, the harder it is to remedy. Ergonomic adjustment alone will not fix Claudia’s chronic symptoms, but they cannot be fixed without it.
If you are experiencing chronic pain or have a health care condition that has been unresolved through conventional means, we at Brian Dorfman Kinesiology might have the answer. Sometimes it takes an alternative perspective to see clearly what a conventional eye has missed. Begin to feel better forever with an appointment with Brian Dorfman Kinesiology today.