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Re: painful shoulder
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Re: painful shoulder - March 21, 2005 3:14:00 AM
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Jon Newman
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From: Amherst, WI
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I'm still suspicious that this test is particularly useful. The study I posted also confirmed the results of active compression test via arthroscopy and got distinctly different results. They tested 426 patients. The original test with spectacular results used 15 patients in the arthorscopy arm of the study.
On a side note. I asked an ortho MD/PhD what would happend if these lesions went unrepaired. He sort of chuckled and started in on a story of how of course our parents and grandparents had these lesions and usually did ok but in today's culture, nothing less than perfect is acceptable. Interesting guy.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: painful shoulder - March 22, 2005 2:04:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Yeah, I think most of these "lesions" end up untreated. I should know, I've got one in my R shoulder as well.
In talking to a surgeon buddy of mine, only about 20% of patients who go to surgery can recall any trauma/MOI.
So there are lots of these people who just get repeatedly labelled "impingement". That's the great thing about knowing this test well, in that if rehab fails, a labral tear may be part of the problem. Even if the test isn't perfect, it can offer a worthwhile avenue to pursue through referral.
In today's society, we are lazy and want everything perfect and easy to acquire. But if we have a patient with chronic pain in the shoulder and we know that a simple arthroscopy might be the missing link in their treatment.... a strong case is made for referral, in my opinion.
J
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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**
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Re: painful shoulder - March 22, 2005 2:37:00 AM
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SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
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Back in my grandparents' time, things were different - mine lived through the depression... were surgeons as talented then as they are now?... and the attitude of not being able to do anything about it prevailed, along with an attitude that complaining didn't do any good. I know my grandparents worked hard - for those in that time period what would be the definition of "doing okay?" If they didn't suck it up and just do their work, they wouldn't have survived. That's just my grandparents though.
Maybe there is a "perfect" attitude in our society. What I do believe is there are choices. Many of us have choices available to us - we can choose to live with whatever condition OR we can choose to do something about that condition. My heart goes out to the financially poor folks who don't have options.
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Re: painful shoulder - August 11, 2005 6:19:00 AM
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kjhsjly
Posts: 15
Joined: September 17, 2001
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okay. well arthrogram showed detached slap lesion. surgery performed and bankart and capsule shrinkage performed. now 7.5 weeks later i have roughly 15 degrees strict ER (no substitutions). MD is thinking manip? any suggestions?
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Re: painful shoulder - August 11, 2005 7:30:00 AM
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Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
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KJ,
I suggest seeing if you can get a scalene block, rather than general anesthesia, have manipulation done by a colleague you respect and trust, with short levers rather than just cranking the arm with the long levers. Simulate the JOSPT study from a few years ago used on folks with adhesive capsulitis with a scalene block. (Roubal PJ. Dobritt D. Placzek JD. Glenohumeral Gliding Manipulation Following Interscalene Brachial Plexus Block in Patients with Adhesive Capsulitis. Journal of Orthopaedic and Sports Physical Therapy (24): 2 66-77)
See if you can get your doc to allow you to do it this way.
Then, do this stretch too, along with the continuation of aggressive posterior, inferior glides and stretches. (Johansen RL; Callis M; Potts J; Shall LM. A modified internal rotation stretching technique for overhand and throwing athletes. Journal of Orthopedic and Sports Physical Therapy 1995 Apr, 21:4, 216-9 )
Let us know how it goes.
Steve
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Steve Hill PT
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Re: painful shoulder - August 11, 2005 9:08:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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KJ-
I agree with Steve. I posted another sample of some research that he mentions above, in the other thread.
It is a case series using the kind of treatment in the Dobritt/Placzek article.
Question:
If you had a detached SLAP, why a Bankart repair? Was your anterior capsule also detached?
Did you have any previous episode of dislocation?
I guess these questions don't help your shoulder come along any, though. :)
If you really want to throw again, it sounds like manipulation is the way to go. We will assume you have tried all stretching/mob efforts you could without success...
Good luck, let us know how it turns out...
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**
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Re: painful shoulder - August 12, 2005 5:18:00 PM
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steel0519
Posts: 3
Joined: August 8, 2005
From: billings, MT
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Check out [URL=http://www.rotatorcuff.net]www.rotatorcuff.net[/URL]
What do Y'all think?
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Re: painful shoulder - August 24, 2005 4:05:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Nick-
Seems like a whole different thread, but we can see some recurring themes:
1. Repackaging of previous information for the purpose of selling it (ie the Buchberger 12- like Kevin Wilk's Thrower's Ten or Jobe/Arm lift exercises, etc, etc...)
2. Extensively extolling the virtues of a particular system (ART and/or Graston) with little research evidence to support it. Though in fairness, it does seem some studies are underway. I'm willing to believe it is helpful in many ways, and a useful therapy. But when the emphasis becomes "certification" and other such charges, etc without proof of superior outcomes, then the skepticism starts to rise. Whether all that's worth the aforementioned 5-8 Thousand Dollars to learn this "system" of therapy is another issue...
3. Appeals to authority and the implication that unless someone has learned a specific set of unproven tools (eg ART or Graston) the "right" way that they will be ineffective or are "bastardizing"(his word not mine) the treatment.
I think we've all seen these themes in websites and ads for lots of different practitioners. When I see this stuff, it really undermines the credibility of the author.
He also seems to take a dim view of non-DCs performing manipulation (go figure) but also is rather harsh about his DC education being incomplete in anatomy and soft tissue skills (I don't know if that's true, but it seems inconsistent with my experience with some good DCs in the past).
How this helps kjh get ROM back in the shoulder, I'll never know...perhaps some much-touted but as yet unproven therapy such as ART/Graston can completely cure him, or we should refer him to Geoff/Ginger for some cervical oscillatory mobilizations...
:)
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**
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