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Thumb and Shoulder Pain, Constipation


  • The client is a 45-year old female with right shoulder pain, right thumb pain, neck stiffness and constipation.
  • The client reports that her shoulder and thumb pain began about 3.5 years ago and appear to be connected to one another.
  • She is not sure if the pain is related to a basketball injury.
  • She describes the thumb discomfort as feeling “poofy” and tight, with limited range of motion.
  • She says the shoulder discomfort is continuous and describes it as feeling knotted.
  • Applying pressure seems to help the shoulder.
  • She has also experienced constipation since she was about 18 years old and usually has one bowel movement each month in conjunction with the timing of her menstrual cycle.
  • She tends to get thirsty and often does not feel quenched after chugging 2-3 glasses of water.



  • The initial postural and range-of-motion assessment reveals tension in right shoulder (both anterior and posterior) and range of motion limitations in the neck looking to the right.
  • A “catch” is observed as the client turns her head to the right.
  • Soft tissue manipulation reveals suboccipital tension along with tension through right side pectoralis major and minor, upper trapezius, rhomboids group, infraspinatus, teres major and minor, and latissimus dorsi.
  • Soft tissue at the base of the right thumb is inflamed, with restrictions felt as the thumb is moved through circular range of motion.
  • Stiffness is also noted in the low back on both sides at the QL.
  • Left shoulder rhomboids group is also noted to have adhesions and trigger points.
  • Pressing and holding trigger points in this region causes considerable point tenderness.
  • With regard to the constipation, the traditional Chinese medicine pattern of disharmony is characteristic of Stomach fire.


  • The client begins with six 60-minute treatment sessions one time per week for a course of five weeks.
  • Her next three sessions are spaced two weeks apart, 4 weeks apart, and 4 weeks apart, respectively.
  • At each session, Chinese medical massage rolling, pressing, pushing, kneading, grasping are performed on the neck, back, right arm and thumb.
  • Cupping is performed on the thumb and on the shoulder.
  • Cups at the thumb are applied at LU10 and LI4. Cups at the shoulder are applied at SI11, SI9, BL42, GB21, BL13 and BL15.
  • Stationary cups are applied at the low back at BL23.
  • Moving cup is also applied over the right infraspinatus, teres major and minor, supraspinatus, rhomboids and upper trapezius.
  • Acupressure points focused on for thumb pain include: LI4, LU10, PC7.
  • Points focused on for shoulder pain include SI11, SI9, BL42/LU2.
  • Points focused on for constipation include ST25, ST36, SP6, GB21, KD1.
  • Round rolling is performed around the umbilicus in the clockwise direction.
  • ST25 is held into for about 2 minutes.
  • SP6 and ST36 are held in combination for about 2 minutes.



  • Following the first session, the client reports improvement in her thumb, although she still feels a “clicking” when she rotates it.
  • She did not notice much improvement in her shoulder, although she did have a bowel movement that week.
  • Following the second session, the client had two bowel movements in the course of a week.
  • She also noticed a difference in her shoulder and feels it is much looser. The thumb continues to improve.
  • Following the third session, the client notices increasingly better range of motion in her thumb and shoulder.
  • She had one bowel movement during the week, in conjunction with her cycle as normal.
  • Following the fourth session, the client had two bowel movements during the week and feels her thumb is close to normal. Her right shoulder is feeling much better.
  • Following the fifth session, the client had three bowel movements during the week.
  • She aggravated her thumb using a pair of scissors and experienced a headache within a few hours of that incident. She was not sure if the two are connected.
  • Following the six session, the client is having 3 bowel movements per week and very little thumb and shoulder discomfort.
  • As everything appears to be stabilizing she will continue with the treatments on a maintenance basis every three to four weeks.