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SC Jt sublux
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SC Jt sublux - February 21, 2004 3:47:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
Status: offline
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This 44 yo male pt (in very good shape, lifts weights 5x .wk) was at work, stepping up on a platform and did not see a metal bar above his head because he had a hard hat on. As he pushed himself up he hit his head (hard) on the bar (had a hard hat on). Later that day he did the same thing again!!! He had no pain that day, but the next day he got pain “under my right collar bone and out at the tip of my shoulder” He also c/o some right sided neck pain. (has been seeing a chiro friend—helps for a day or two) He could not remember what he was doing the next day when the pain came on. This pain has been the same over the last 3 months….
He c/o increased sub – acromial pain with shoulder abd and he can not do a shoulder workout (shoulder press ect..) He gets pain at his SC jt with horizontal ADD and has pain with benchpress. His SC jt also swells up
Exam: Cerv spine: P/A/R motions were not too impressive. C/O some increased pain with right foramen compression (Ext/SB/Rot right). Increased pain with compression (min) and decrease with traction. All sx were felt right in the neck.
The pt had sig edema at his SC JT. Pain with horizontal Add (no pain when I push AP on SC jt with horz Add) Has no pain with SC jt mobilization. No crepitus at the SC jt. Stretching of the SCM and contraction of it did not cause any pain.
Is this a subluxed SC jt? And how did hitting his head cause his SC jt to sublux?
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Re: SC Jt sublux - February 21, 2004 3:37:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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Of all the SC joint subluxations I have seen (usual mechanism is a jam during hoops or checked into the boards), the joint is still reduceable. Is this swelling truly new, and actual fluid swelling? Or, is this just what he told you?
Now the distal clavicle pain I can understand being referred from the cervical spine. I have found through personal experience that C6-7 can definitely refer pain to the posterior tip of the acromion, and even create tenderness just on the edge....enough to make you swerar it was infraspinatus tendon/AC joint issues going on.
There are probably mechanisms that we could hypothesize could have occurred, such as reflexive contraction of the SCM pulling the proximal clavicle caudially, etc. However, with everything you tested, it does not seem likely.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: SC Jt sublux - February 21, 2004 3:39:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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Just another thought popped into my head. Osteolysis of the distal clavicle is not that uncommon in weightlifters. Perhaps proximal osteolysis could occur by some other mechanism. Just a thought!
Duffy
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Re: SC Jt sublux - February 22, 2004 4:44:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
Status: offline
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Thanks for the input. There is no doubt that the pt has edema over his SC Jt. It is very noticeable. I have seen this pt before and he always has weird sx. Last time I saw him he came in for tennis elbow. He had zero pain but got sig edema at his lateral elbow and forearm after working-out. Not to mention he was limping and he asked me to look at his foot which he hurt 2 days ago. He had a torn Achilles!!
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