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Re: Painful Shoulder
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Re: Painful Shoulder - May 7, 2004 4:12:00 AM
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Shill
Posts: 1096
Joined: February 13, 2003
From: Madison WI USA
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Pilatespt,
So what is your point ? :confused:
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Steve Hill PT
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Re: Painful Shoulder - May 7, 2004 9:05:00 AM
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PTstud
Posts: 86
Joined: March 8, 2002
From: Texas
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ArmyPT,
Neural tension stretches? I was told in school that stretching a nerve is actually harmful to the nerve itself. Do you mean neural flossing? This doesnt involve neural tension or stretching but nerve mobilization.
pilatespt-dont pass yourself off like a PT student, they wouldnt talk like that. You're probably some envious member of another profession.
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Re: Painful Shoulder - May 7, 2004 11:14:00 AM
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durst mary
Posts: 7
Joined: May 3, 2004
From: audubon nj usa
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the problem that you may be having with the painin your should maybe because the nerve is still inflamed from the surgery and accident that you had. did you therapist do any form of desenstizing of the affected area using russian stim and ultra sound using phophresis gel with 10
percent cortizonsgel ask your upper extremity speacilist about this it may help
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mary durst lmt/ma
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Re: Painful Shoulder - May 7, 2004 11:33:00 AM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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Thanks for the reply army.
Durst mary, it may be of benefit to re-read the entire post, it seems you are confused about this case.
What happened to pilatespt post?
jon
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Re: Painful Shoulder - May 7, 2004 2:28:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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PTstud
It is true that neural stretches have been replaced by mobilisation/flossing. Ten years ago it was usual to do sustained neural stretches lasting several minutes - it has been shown this can be detrimental. (David Butler)
To test, however, the 'stretch' lasts for only a few moments; turning it into a treatment requires a much more sensitive approach. I find it very useful to watch the patient's face at all times, as well - it is a giveaway for a patient who is trying to be 'stoic'...
Nari
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Re: Painful Shoulder - May 7, 2004 11:33:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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I am sorry for the confusion. What I mean by neural stretching are moblizations performed by the therapist like Nari describes. The movements are done passively by the therapist while monitoring the patients pain and symptoms. I did not mean static neural tension stretches. Sorry for the confusion.
Army
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Re: Painful Shoulder - May 10, 2004 8:45:00 AM
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sprite
Posts: 22
Joined: April 21, 2004
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I have an update. All ULTT negative. Empty can weak and painless; full can strong and painless. Pain with horizontal add (I had him protract before moving into horiz add). Still point tender RTC insertion and 20% pulsed US at 1.0 w/cm increased discomfort in that area.
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Re: Painful Shoulder - May 11, 2004 3:07:00 AM
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Sebastian Asselbergs
Posts: 1205
Joined: September 29, 1999
From: Barrie, Canada
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Sorry to drop in this late. In scanning this topic, I failed to find mention of x-rays...if they aren't available yet, they would be the cheapest and quickest way to eliminate/confirm a few serious potential pathologies (SJ mentioned CA...). If they are clear, I agree that scapular motion is crucial to proper motion of the scapula. Weak "empty can" means that there is weakness; it is not an accurate diagnostic test, especially in view of 5/5 testing of RTC initially. Why could this not be a stubborn and unusual rotator cuff impingement of slow adaptive insidious onset related to old capsular and/or labral injury? That darn scapula needs to be checked, and if hypermobile, patterns-restoration need to be introduced in the treatments before any long term improvement can be expected; conversely, if scapula moves poorly (seen it rarely!) it needs to move.
Just some thoughts in addition to all the excellent posts.
BTW, what's this about pilatespt and where is s/he?
Sebastian
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Mundi vult decipi
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Re: Painful Shoulder - May 11, 2004 4:17:00 AM
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sprite
Posts: 22
Joined: April 21, 2004
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Sorry, I have been meaning to add that x-rays were negative.
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Re: Painful Shoulder - May 11, 2004 12:55:00 PM
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rolf-inge
Posts: 23
Joined: May 10, 2004
From: norway
Status: offline
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Hi all!
As i wrote in the lat.epicondyl topic.Have you examined the m.scalenii on the right side ,compared to the left side.
The MVA can have increased the tension in this muscle,i have experienced this quite often!
1.What about tension in this muscle,by palpation for triggerpoints compared to the left side
2.Active and passiv lenght differences,lat.sidebending,with and without elevated shoulder(to differenciate between nerve involvment or not)
3.Have you palpated the nervetrunks in the axilla,sidedifferences?
4.What about his breathing pattern in sitting position?
Have there been some emotional stressfull events/situation (family/jobb)before the shuolder became apainproblem?
I hope you understand my "baby"english!
Good luck!
RIN
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RIN
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Re: Painful Shoulder - May 11, 2004 4:03:00 PM
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hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
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OK. Did I miss something? Who is pilatespt and what did he/she post? I'm just being nosey.
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Holly Gross PT
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Re: Painful Shoulder - May 12, 2004 4:23:00 AM
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Neil Spielholz
Posts: 4
Joined: January 28, 2001
From: Coral Gables, FL USA
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I know I'm, getting in on this kind of late, but another possibility in a patient presenting with sudden onset of shoulder pain (frequently described as having awakened with it) is brachial plexitis, also known as brachial amyotrophy also known as Parsonage-Turner syndrome. These people initially have severe shoulder pain, usually first diagnosed as bursitis, tendonitis, rotator cuff tear, etc. The pain is so severe, they need fairly heavy medications. After a few days to about a week, the pain subsides but then atrophy and weakness is noted in one or more nerve distributions. The most commonly-affected nerves are the suprascapular, axillary, and long thoracic. They can be involved either singly or in combination. The most common combination is suprascapular and axillary. Less common involvement is in the anterior interosseous nerve distribution. However, if this particular patient does not have obvious weakness and atrophy, then he is not one of these. I'm just mentioning this as a possibility. By the way, the prognosis of brachial plexitis is good. Spontaneous recovery usually takes place within 6-12 months. And just to complete the differential diagnosis, one would also have to rule out suprascapular nerve injury in the region of the suprascapular notch (affecting both the supraspinatus and infraspinatus muscles), or ganglion cyst in the region of spinoglenoid notch (affecting just the infraspinatus).
By the way, how is the patient doing?
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