|
|
Re: Intense shoulder and arm pain
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: Intense shoulder and arm pain - February 26, 2007 9:53:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1206
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
mt....."her non contractile supporting structures have shrunk down to 1/4 their voloume."
reference please?
And please: her arm is being immobilised by contractile tissues. Think. Non-contractile tissues don't shrink of their own volition: they may (MAY) get dehydrated and tighten up, but ONLY if the muscles hold the shoulder still....
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Intense shoulder and arm pain - February 26, 2007 9:58:00 AM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
MT, Seeing as you apparently have all the answers, why dont you go enjoy a moment to yourself in private, where you can revel in how smart you are.
Degenerative tears = Lack of active motion = eventual capsular restriction, unless one of her friends advised her to lift her arm overhead frequently to prevent this. Also, knowing if there is a cuff available to rehab is helpful towards determining prognosis. Dont you agree?
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Intense shoulder and arm pain - February 26, 2007 10:48:00 AM
|
|
|
matotoms
Posts: 57
Joined: February 16, 2005
From: nbn
Status: offline
|
no reference..i pulled that 100% out of my arse.
[QUOTE] And please: her arm is being immobilised by contractile tissues . Think. Non-contractile tissues don't shrink of their own volition: they may (MAY) get dehydrated and tighten up, but ONLY if the muscles hold the shoulder still....
[/QUOTE]adhesive CAPSULITIS is a contractile tissue issue? OK. guess i need to read up on it.
RA attacks the joint capsule and synovium directly.
yes if she had a RC tear or contractile tissue issue..it could lead to adhesive capsulitis.
But once you have 10 degrees of motion at the GH joint in all planes and intense pain at rest..then mobility is BY FAR the chief concern, no matter how the joint got so tight.
who cares if you have a RC tear if you can only lift your arm 10 degrees b/c the joint capsule is so tight....FOR THE PAST 3 MONTHS.
how would your tx plan change based on RC integrity on an 85 yo woman that has 3 month hx of adhesive capsulits, severe pain at rest, 10 degrees of motion in any plane, a HX of RA and recently off the RA meds.
honestly.
id bet a billion dollars this lady gets nowhere until she gets some correct meds to control the inflammation/RA in her GH joint.
|
|
|
|
|
Re: Intense shoulder and arm pain - February 26, 2007 11:25:00 AM
|
|
|
KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
Status: offline
|
Did you rule out the neck??
|
|
|
|
|
Re: Intense shoulder and arm pain - February 26, 2007 11:38:00 AM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Mt,
Who says we arent concerned about mobility? How much of a chance does she have of keeping mobility, and gaining a normally functional arm, without a rotator cuff? The MRI is a luxury that has already been done. Its information could be helpful in prognosis in the end. I never said, or even remotely mentioned that mobility wouldnt be the priority.
When one gains motion in treatment for adhesive capsulitis, often strengthening is done within the newly gained range. If the RC is gone, it wouldnt be able to be strengthened. Thats why it matters. Training special or adaptive movement techniques knowing that the typical techniques wont work without a cuff is also important.
Im not saying you are incorrect on your idea of an inflammatory response due to her RA. Im saying to see the big picture, and plan for discharge from day one, inform the patient that the end outcome may not be too great if the MRI results come back showing cuff tears. For a patient with Medicare B, as this 85 y.o. undoubtedly has, it is a therapist's responsibility to estabilish a reasonable rehabilitation prognosis.
Sincerely,
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 8:48:00 AM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
MRI revealed RC tear, will see ortho tomorrow. Not sure how big or how old this tear is.
Or, if it is even the cause of her severe pain. I set her up with a TENS unit today.
Will try kinesiotaping for positive sensory stim to decrease pain if she comes back from ortho.
She is also seeing her oncologist next week. I have urged her to speak to the physician regarding concerns or CA being the possible cause of the pain as I know that MRI is not necessarily going to pick it up.
More to come. Thanks for all of the advice and discussion - always a pleasure to learn from you all.
Eric
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:07:00 PM
|
|
|
jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
|
Man, I hope to God the ortho doesn't decide to "repair" an 85 year-old RTC!! I'm sure the surgery and the 3+ months of rehab will be good for her. Oh, and having adhesive capsulitis on top of that is even better.
They should just send her back to you (assuming no mets) and let you restore her PROM and then gain as much AROM to shoulder level as possible allowing you to teach compensatory strategies to resume her ADL's again. That might take 3 months in itself, but she wouldn't have to "make it" through surgery to get there.
Try to keep us updated on her progress if you can.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:10:00 PM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
My guess is that this is the result of combo RA and deg cuff tear with resultant adhesive capsulitis. Not sure if she is a surgical candidate. The thing that threw me was the intense pain this lady was / is in with a (probable) old tear and 3 month history of pain and limitation. Clearly the most apprehensive and guarded patient I have ever worked with in 10+ years.
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:11:00 PM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
Jason:
I hope he doesn't consider surgery either!
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:14:00 PM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Eric,
Have you tried just taping the humerus into the glenoid? Ive had a few of these older patients with massive inoperable tears and find that they get significant relief with this technique. If it works you can try and find a shoulder brace that allows movement but stabilizes the humerus in the glenoid.
Steve
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:18:00 PM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
Steve:
Kinesio or leukotape?
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: Intense shoulder and arm pain - February 28, 2007 1:35:00 PM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
leukotape: use 3 bands mimicking the pull of the rotator cuff muscles. One from the anterior deltoid pulling in a diagonal posterior/superior direction one from the medial deltoid to just before the trap and one from the posterior deltoid in a diagonal anterior/superior direction. With each band of tape, pull the humerus superiorly into the glenoid.
I wish I had a picture of this technique, dislocators love this tape job as well. Unfortunately the only brace I know that mimicks this tape job is mad in Australia by a woman whose name escapes me at the moment.
|
|
|
|
|
Re: Intense shoulder and arm pain - March 1, 2007 2:17:00 AM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
As you know, you will need to be careful with tape of any kind on 85 year old skin. The thin, watery skin often found in this population just does not do well with use of tape, and especially repeated use of a firm and strong holding tape such as the cover roll and leukotape combo. Not to mention the difficulty donning in the case of RA and potential hand deformities, reduced support systems, etc. If there is a brace for comfort, I'd go that route too, with frequent bouts of exercise (AAROM)out of the brace during the day.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Intense shoulder and arm pain - March 1, 2007 5:31:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Steve,
I agree with this population not tolerating tape well, I will often put a small piece somewhere on their arm to see the skin reaction.
The lady who makes these braces is an Australian physio named Lynn Watson. Here is the link to the brace I talked about:
http://www.sportstek.net/mslw.html
It doesnt immobilize the shoulder, just provides support.
|
|
|
|
|
Re: Intense shoulder and arm pain - March 1, 2007 7:43:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
Good to know that she has a RC tear. Personally, I'd still R/O a metastatic tumor.
Shill has a very good point - the skin of an 85 year old just doesn't have the elasticity or the properties of skin of 40 year olds and will have a potential of tearing upon removal or a potential of irritating.
Technically, I'd question adhesive capsulitis. If you can't get an endfeel because of pain, then technically that diagnosis can't be made.
If she is right hand dominant, she is going to need intervention to enable her to maintain her independence. If you aren't able to reduce her symptoms and if her disability scores are high, she could be a candidate for an injection for pain control and then back at you for rehab.
Remember with bracing, Medicare has had DMO changes... research the ability for her to have medical coverage for the brace you choose. If there is no coverage make sure you investigate the cost so she can make a well-informed decision versus thinking she can just have a brace.
The size and location of the tear will be variables that will assist in determining a prognosis for her future.
|
|
|
|
|
Re: Intense shoulder and arm pain - March 1, 2007 4:33:00 PM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
SJ, You are right about the adhesive capsulitis.
It seems to have been accepted as true that the patient has this condition but with very little to substantiate it.
Firstly she is too old. Secondly she had intense pain and so it is possible she has a full active and passive range but is unable to perform. Thirdly she can sleep on the affected side. It is possible she has a traumatic arthritis but it was claimed she suffered no accident. She may not have remembered of course. With a traumatic incident at 85 years immediate treatments of passive and active movements to a shoulder almost always results in a quick resolution, but, if untreated for even a few weeks as they usually are, cause great pain and suffering. No muscle wasting is usually present. Monarticular Rheumatoid steroid - sensative arthritis only rarely occurs after 70.
It is heartning that no eye signs or muscle weakness, or flushed face was noted.
If it were my shoulder and nothing morbid was found I would begin with an injection of local into the bursa and if no change one into the joint.
Jim McGregor
|
|
|
|
|
Re: Intense shoulder and arm pain - March 12, 2007 9:16:00 AM
|
|
|
james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
|
Eric, Any resolution to this patients troubles?
Jim McGregor
|
|
|
|
|
Re: Intense shoulder and arm pain - March 14, 2007 10:00:00 AM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
Jim:
No significantly. She is tolerating some PROM, AAROM. Kinesiotaping seems to be helping as well.
Eric
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
 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 |
|
0.094
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: Intense shoulder and arm pain 
