|
|
bilateral elbow and forearm pain s/p breast reduction
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
bilateral elbow and forearm pain s/p breast reduction - April 11, 2006 10:15:00 AM
|
|
|
VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
|
Today I was referred a patient with a hx of breast reduction 7 weeks ago. She is coming to me for a left elbow ROM restriction developed immedietly after the first week of immbolization follwing breast reduction.
The time line goes as follows:
0-1 week. No UE movement per MD order
1-2 weeks: elbow motion only at side. Left elbow ROM restriction starts here.
2-6 weeks: elbow ROM restriction slowly improves and is now able to fully extend elbows, but still feels some discomfort at full elbow extension on the left. During this time she also develops forearm pain (think radial nn elbow to finger distribution). THe left forearm has "radial distribution" muscle ache, the right forearm has "radial distribution" sensory issues. I.e. after 30 minutes of typing her right forearm felt cold as ice.
Week 7: Eval date. I see her now due to the slow Tricare referral system. She is left with occasional forearm pain in bilateral UE's and the the right forearm feeling cold to the touch after axtivities such as typing for longer than 20 minutes.
Her GH flexion is ~140 before she starts feeling restrictions from her incision.
I cleared her c-spine, was negative for TOS (radial pulse did not diminish during Adson and Allen, forgot about ROOS), negative for lateral epiconylXXXX. Negative ULTT for Median/Ulnar/Radial.
I am working on improving her GH ROM and trying some nerve glides to see if there are brachial plexus nn adhesion going on possibly from positioning during surgery or ones developed from immobilization. I have instructed her to make sure her scars stay mobile and instructed on and gave her some info on general self -massage. I really don't have any other ideas on why this could be occuring.
Any help?
Thanks
Dan
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 11, 2006 12:51:00 PM
|
|
|
Synergy
Posts: 596
Joined: March 11, 2004
From: Texas
Status: offline
|
Dan,
Sounds like you're on the right track. Along with improving the UE ROM, you may want to try some cervical side glides/mobs with the UE in a ULNT position. It sounds like neurogenic-type pain to me, despite her negative tests. I'm sure others will add to this.
Interesting patient. :)
_____________________________
Chris Adams, PT, MPT
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 12, 2006 2:32:00 AM
|
|
|
eam
Posts: 293
Joined: February 5, 2004
From: New York, NY 10028
Status: offline
|
Hi Dan-
Also sounds "nervy" to me. I would continue with the glides and add some cerv. positioning as Chris mentioned. How is her 1st rib? Scalenes? There may be a little oompression from there as well. Ineresting case.
Erica
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 12, 2006 6:34:00 AM
|
|
|
dosrinc4
Posts: 10
Joined: January 28, 2005
Status: offline
|
Dan,
try looking along the lateral chest wall, long thoracic nerve, serratus and lats, palpate in the axilla and see if you can reproduce any of her symptoms, could be this medial aspect of the plexus was compressed during prolonged surgical positioning.
Rick
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 12, 2006 6:37:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Dan-
You've got great advice here, I second all of it.
I would look again at peripheral neurodynamics as well, biasing your ULNTs to focus on the elbow/forearm area (ie move and position everything else first a la Shacklock).
This sounds like a classical abnormal neurodynamic.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 13, 2006 2:33:00 AM
|
|
|
Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
I third all of the above advice, and to also watch for lymphedema, depending on what was done with the axilla during this procedure. If youve ever seen one of these surgeries, it is far from a gentle removal of tissue. Shoulder and C spine ROM, neural mobilization, along with incisional STM if the incisions extend to the axilla and lateral upper quadrant. You may find that shortening the skin (and other soft tissues)manually near the inscision while you abduct or flex the shoulder allows for greater ROM with less pain. (press firmly and drive tissues in a cephalad direction while passively flexing or abducting in supine or sidelying). Then slowly let off the shortening to tolerance.
Good luck!
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - April 27, 2006 7:28:00 AM
|
|
|
VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
|
New Twist!
Patient was has progressivly decreasing symtpoms until her mentrual cycle that started this week. Her UE symtoms were alomst completely gone then she had her cycle, her breast tissue swole, and her forearm symptoms returned. I am thinking this is more soft tissue related.
I am waiting on her cycle to finish to see if her symptoms resolve again.
Thanks for all the help so far, especially Shill. That tissue work during ROM worked well to make her more comfortable.
|
|
|
|
|
Re: bilateral elbow and forearm pain s/p breast reduction - May 29, 2006 6:53:00 PM
|
|
|
PTdirector
Posts: 11
Joined: May 24, 2006
Status: offline
|
One thing to consider is that many of the Tricare patients are building disability cases and will be able to increase their disability ratings and thus their "Service Connection" which is the amount of free medical service and tax free retirement income they will receive. I have treated multiple Tricare patients that I felt were not being completely honest with me and I would mention to one of the other therapist that I felt that they were building a disability case due to the lack of objective findings to corraborate their complaints. And in every one of the situations we later received medical records requests for disability claims.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
