|
|
Re: my shoulder
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: my shoulder - June 1, 2006 12:31:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Gerry
The 'catch' you mentioned may not be physical; if you do an unexpected movement which aggravates sensitivity, there will be a sudden 'bite' of pain. It cannot be assumed that there is physical damage; eg RC tear, labral tear, etc with this sort of pain. The only way to diagnose is with imaging of soft tissue.
I have seen many 'tears' of tissue resolve without any (rather) brutal stretches and exercise; by neural mobilisation. Even if there is a physical damage, it is still helpful to reduce the sensitivity.
Can you ask these PTs if they know about neural mobilising/glides/sliders?
Nari
|
|
|
|
|
Re: my shoulder - June 5, 2006 4:41:00 AM
|
|
|
PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
Status: offline
|
Ask your PT to perform the Obriens test on your shoulder, it has pretty decent reliability for SLAP lesions.
if not MRI/CT arthrogram to be 100% sure.
good luck
|
|
|
|
|
Re: my shoulder - June 5, 2006 7:33:00 PM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
Gerry,
What is your sleeping position? I had a similar problem with my shoulder, and like you sometimes it would feel like it almost wasn't there and then something would make me move my are a certain way or more quickly and the pain would just stab me. I finally figured out the cause, my daughter was sleeping with us at night and I was placing my arm underneath her and sort of sleeping on it. My guess is that I was compressing the nerves. I switched positions and kept my arms strictly neutral and below shoulder level at night and it cleared up quickly.
|
|
|
|
|
Re: my shoulder - June 6, 2006 6:22:00 AM
|
|
|
gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
|
Thanks again folks!
Nari, I'm having a tough time finding a PT who does neural mobs, maybe I'm just not asking the right questions. Need to call around some more. Thanks for the encouragement to do so.
PHSPT, I've had the MRI with contrast allready, and nothing major showed up. However, what I read is that many labral tears are missed by MRI, and are found by scoping? The Obrien's is not positive. Perhaps I'm just reaching, hoping something will be found so that something can be done. It seems so many of the specific tests are equivocal. I think there are multiple things going on. It does seem there is some involvement of the long head of the biceps, as some of those resistive tests are positive. Also, I was trying to add distance to my disc golf throw. The biceps elongates during the backhand throw, and helps stop the arm after release with the shoulder in abduction, extension and varying rotation.
Randy, I tend to change positions a lot at night. I used to fall asleep with my arms above my head, but it has been 6 months or more since I have been able to do that with my right arm. Looking back, I think that was one of the very first "problems" I noted. After sleeping with my arms abducted/externaly rotated, positioned above my head, there was some pain when bringing my right arm back down. Now it is very hard to find a position of comfort at night. That is one of my major complaints. I'm getting grouchy from decreased sleep. That is the major complaint of my family :)
|
|
|
|
|
Re: my shoulder - June 6, 2006 7:20:00 PM
|
|
|
PTdirector
Posts: 11
Joined: May 24, 2006
Status: offline
|
Gerry,
I saw several people suggest that you have a therapist look at your cervical spine as well. If you get a test suject and palpate C7 and then attempt to raise your arm overhead, at about 90deg of elevation you will note that C7 spinous process will move to the contralateral side and inferiorly and the opposite occurs with reaching behind your back meaning that hypomobility of the lower cervical spine can affect proper glenohumeral function as can C5 dysfunction as it has a myotomal distribution at the shoulder and controls motor function in the RC muscles. Many of my impingement patients benefit from aggressive glenohumeral mobs to the posterior capsule as others have suggested and the most comfortable mob (for the patient) that I have found is using my chest to press down into my patients elbow through the long axis of the humerus while distracting with my hands at the glenohumeral joint. It is an amazing mob and you should notice immediate improvement in your shoulder mobility. Another good mobilization is for the patient to place their hand behind their back and the therapist will distract at the humerus and forcefully pull down on the arm in order to achieve a strong grade IV inferior glide which should be held until you notice the upper trap and shoulder to relax. Once again, you should notice immediate improvement in pain and mobility with reaching behind your back. Finally, Brian Mulligan has a posterior/superior taping technique of the glenohumeral joint that provides significant relief for many of my shoulder patients with tight posterior capsules. I don't know if this will help but is worth a try.
|
|
|
|
|
Re: my shoulder - June 7, 2006 12:04:00 PM
|
|
|
gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
|
Another quick update. Found a PT today who is knowledgable regarding neural mobilizations. He also recommended we look at the cervical spine, so will be setting up an appointment with him soon.
This whole experience has been valuable to be as a PT, and perhaps one day I will look back and incorporate some lessons learned. I was suprised at how difficult it was to find a PT willing to look at my shoulder from a neurologic point of view. Most dealt with tight shoulders by stretching, stretching and more stretching. And maybe some modalities to make the stretching more tolerable. One PT boasted about making people cry because of her stretches...ouch. I just don't see how that is supposed to help.
I'll continue to update as long as y'all tolerate my posts. Kind of helpful to me to log the progress.
|
|
|
|
|
Re: my shoulder - June 7, 2006 12:19:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Gerry
I think you are on the right track. Stretching is not a good rationale; the brain/CNS will win most times, when we are talking about sensitisation.
A stiff painless structure will probably respond better to force - although I reckon force is never appropriate.
Keep posting!!
Nari
|
|
|
|
|
Re: my shoulder - June 7, 2006 12:28:00 PM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
Gerry,
If your posterior capsule is tight, I recommend the sleeper stretch, sidelying on affected side, shoulder flexed to 45, 90, or 120 in front of you on table, elbow bent to 90 degrees. Use your other hand to push down into internal rotation of affected shoulder. Try rotating your trunk toward or away from your arm a little to get more or less stretch. Do this in a few of the different positions to stretch different parts of the capsule.
How stong are your internal rotators? You may have muscle imbalances with long, weak internal rotators (subscap and pecs) and short, tight external rotators. Strengthen the IR's and stretch the ER's. Is your humerus sitting anterior or superior in the socket? (compare with other side).
Sarah
|
|
|
|
|
Re: my shoulder - October 18, 2006 7:29:00 AM
|
|
|
gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
|
I posted another question regarding my son, so I thought I should update this old post for any interested.
Cervical spine was cleared. Second PT agreed with the first PT that there seemed to be something else going on in my shoulder besides only adhesive capsulitis. Orthopedist was willing to do a manipulation under anesthesia and arthroscopy. After hurting for so long, I was ready for anything, but thought I would get a second ortho opinion. Second ortho thought it was classic adhesive capsulitis, and injected what seemed to be about a quart of steroids into the joint. (The previous injections were into the bursa.) Also prescribed Naprosen and Ultram.
That was back in July. The pain decreased over the next week and has remained in check. I was so glad to not be hurting, I left everything alone. I tapered off the meds a couple of months later, and no longer take any meds. My shoulder is improving in range very slowly, and has remained pain-free. I'm trying to get more range in shoulder motion while maintaining scapular stability.
Not sure what lessons I have taken away from this at this point, but I know there will be a change in how I look at things. I appreciate all the suggestions and input from you guys.
|
|
|
|
|
Re: my shoulder - October 18, 2006 10:38:00 AM
|
|
|
gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
|
I think it was the steroid injection in combination with the continual Naprosen. Perhaps it interupted the cycle of pain, or perhaps I was entering the second phase of adhesive capsulitis anyway where the pain decreases and the primary problem is stiffness.
I never had the arthroscopy or manipulation. I actually had it scheduled, but decided to get the second opinion first. The second orthopedist said he would not do either until after the painful stage had resolved. Now that it has, I'm trying to avoid any surgery by slowly increasing the range myself.
|
|
|
|
|
Re: my shoulder - October 18, 2006 11:26:00 AM
|
|
|
Raulan
Posts: 1
Joined: September 19, 2006
Status: offline
|
Gerry,
Have you considered that your shoulder problem may be more deeply rooted. I would evaluate rib cage position of right versus left, I often find that the right rib cage is in an internally rotated position. This leads to mal-positioning of the scapula on that rib cage and consequently mal-adapted functioning of the muscles. Typically this can lead to hypertonic subclavius, pec minor, and present as internal rotation weakness, I would however not consider it weakness, but positional weakness(leverage and length-tension issues). This positional issue will also present as limited humeral-glenoid internal rotation.
|
|
|
|
|
Re: my shoulder - October 23, 2006 10:31:00 PM
|
|
|
rv36116
Posts: 216
Joined: August 5, 2006
From: Texas
Status: offline
|
Any McKenzie folks willing to take a stab at this one vs. me blabbing about this one?
Sounds like about 75% of the shoulders I see, fix quite rapidly w/a movement or two.
Crappy part is, it sounds like the run-around most of these folks get before coming to us with about everything in the book tossed at them and no relief.
Did you pretty much get the large injection and leave it alone for a bit?
|
|
|
|
|
Re: my shoulder - October 24, 2006 4:15:00 AM
|
|
|
ptim
Posts: 68
Joined: September 26, 2006
Status: offline
|
What lessions can we take away from this?
Don't make it too complicated!
If it looks, acts and behaves like an adhesive capsulitis, maybe it is.
X-ray, CT, MRI too many false positives!
I've done some of the McKenzie stuff.
The neck can be cleared quickly with baseline movements, if there's no loss of motion and movement doesn't influence the shoulder presentation, then move on.
If the pain is consistently produced at end range (and no longer chemically driven pain) as with an adhesive capsulitis/articular dysfunction, then stretch it 2-3 hours.
I see alot of rapidly changing shoulders using repeated end range motion, but this doesn't sound like the case. I always look at repeated IR and/or extension first to see if it changes the mechanical presentation.
In McKenzie's book it says if behaves like a 'capsulitis' but still has a strong chemical component then leave it alone for a couple of weeks as mobilizing/stretching will just irritate the joint
No that the inflammatory component has been addressed with the cortisone start restoring motion. Mckenzie says start with IR X10/2-3hourly
|
|
|
|
|
Re: my shoulder - October 24, 2006 4:58:00 AM
|
|
|
gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
|
I'm still incorporating lessons I've learned from this.
Rob, yes, I left it alone after the last injection. I had been working on it for months, and kept feeling like I was only irritating it more. I would love to hear what movement you have had so much success with. I'm continuing to learn and look forward to your perspective. The last PT who worked with me and cleared my neck was McKenzie trained. Another McKenzie trained PT I asked for a consultation bragged that she had stretched clients until they cried. I decided to go somewhere else...
Raulan, I did not look specifically at the rib cage, but will keep that in mind. There were several PTs who looked at my posture, so hopefully one would have picked up on it if it was significant.
ptim, I agree with not making it more complicated than it needs to be. I think I kept looking for something that could relieve the discomfort, and so kept seeing other possibilities for what was causing the pain. I do think there was an underlying injury, and may have to deal with it in the future. But it may be that the adhesive capsulitis and slowly dealing with it allows the underlying injury to heal on its own? It would have been nice to speed up the recuperative process, though. Perhaps patience is one of the lessons I will try to take away. Could you elaborate a little on the IR X 10/2-3hourly? What position is the shoulder in? Are you talking about doing the 10 reps every 2 - 3 hours, or doing 10 reps 2 - 3 times every hour?
Thanks again!
|
|
|
|
|
Re: my shoulder - October 24, 2006 8:41:00 AM
|
|
|
ptim
Posts: 68
Joined: September 26, 2006
Status: offline
|
Repeated Internal rotation (arm behind back)10X every 2-3 hours, pain on/pain off. As long as you don't get any lasting pain
|
|
|
|
|
Re: my shoulder - October 26, 2006 10:57:00 PM
|
|
|
rv36116
Posts: 216
Joined: August 5, 2006
From: Texas
Status: offline
|
or, if it's a derangement, that could clear up quickly w/that treatment explored 1st...Take some baselines, perform IR w/sheet pull (to end range, and yes, it will hurt) & check the baselines...
|
|
|
|
 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
