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ginger -> case hx, upper limb pain in older cyclist (February 15, 2006 2:49:00 PM)
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interesting case managed up to last week and discharged. 4 weeks treatment with 6 occasions of 45 mins in my rooms.
67 year old cyclist, 187 cms, 72 kgs, quite fit,( described self as a yard and a half of salty pump water )regular distance cycled around three hundred Kms per week.
Complained of L upper limb pain, including,
L thumb. pain felt with most thumb movements at scaphoid, extending into PIP, worse with palmar opposing forces and extension, grip strength good but less than R by 40 percent. (right handed )
L>>R elbow, lateral epicondylar area pain , including wrist extensors through to wrist.
Tingling and numbness to ulnar distribution L 5th digit ( especialy when riding)
L>>R shoulder pain , mostly posterior aspect, though including lateral and anterior . pain increasing with elevation , full range limited by tightness of soft tissues within GH joint and pain .able to abduct and flex to 135 only actively, passive to 160.
pain felt L>R upper thoracic spine , extending into L>R chest anteriorly, difficulty with deep inspiration. Scapulo/humeral rythym reveals tightness generally to subscapular structures and poor recruitment of elevators, retractors. L>R.
evidence of brachial dural tightness L>R
This retired Australian Air Force Wing Commander was a cheery self motivated outdoors man keen to ride.
Treatments#1 16/1/06
Mobs C1 to T8 L 2 to 5 mins each with effective resolution evident to hypertonic paravertebral muscle with equal improvements to comfort and resistance to passive facet joint mobility. Able to elevate to 145 L shoulder, 160 R without pain, reduced Lelbow tenderness and improved active range of L elbow.
Treatments 2, 3, 4 over january proceeded with mobs as above, with incremental improvements evident to range and comfort of Shoulder function. Dural stretches commenced treatment #3 ( sharp ballistic with upper limb pulled sharply in to wrist and finger, elbow, shoulder lateral extension 3x10 )
R upper limb pain free as at treatment #3. L thumb pain improved as per wrist and shoulder with improved scapulohumeral rythym and normalisation of cervical and thoracic movements.
somewhat persistant T3456 pain with mobs which eventually settled by treatment 6.
Subscapularis , gleno/humeral and brachial dural stretches very effective in reducing pain associated with elevation. limited still at 170 degrees L=R into abd/flex , end of range limited by glenoid capsule tightness but thought not to be a bother.
Overall a good recovery from a hx of gradual tightening and discomfort. Reports today the L thumb is only slightly difficult but a break from treatment recommended, re assessment scheduled for March after his holiday to nepal to ride the mountain trails.
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