>
>
In response to your comments it is important to determine through your
examination the specific nature or diagnosis of the patients disorder. If
they have a neurogenic pain disorder with pain reproduction with
longitudinal nerve trunk provocation tests (and the other features of a
neurogenic pain disorder such as a cervical radiculopathy) then it is quite
possible that there may be a limitation of active and passive shoulder
mobility but this is not a frozen shoulder.
On the other hand, patients with true frozen shoulder may have some
discomfort associated with the neural provocation tests but this does not
mean that they have a neurogenic pain disorder. This could be confirmed
through palpation of nerve trunks for neural hypersensitivity (tegether
with the pattern of movement restriction). If this is not present, one of
the key elements for the clinical diagnosis of a neurogenic pain disorder
is missing.
Therefore it is important to determine what is the primary nature of the
patients disorder. It would be highly unusual for a patient to have
co-exising true frozen shoulder and a neurogenic pain disorder. Finally, it
is important to remember that the longitudinal neural provocation tests are
primarily tests for pain reproduction, not tests of (neural) mobility.
Findings of limited straight leg raise would seem irrelevant to the
disorder of frozen shoulder (unless of course the patients shoulder/arm
symptoms are reproduced by the SLR test.
Steve.
>"Anna Lee, Principal" wrote:
>
>No concrete evidence, but it may be because they have overused the remaining
>unaffected limb because of the severe pain in the original affected side.
>Not only is that a result of the pain, but you will see clearly the abnormal
>movement patterns with the whole upper thorax and neck-shoulder complex
>which is bound to have an effect on altering biomechanics.
>
> As a Physiotherapist working mainly in the area of hydrotherapy and
>remedial exercise, I see a lot of "frozen shoulders", mainly as a
>treatment of "last resort"...unfortunately. Overall the history of
>insidious onset "frozen shoulder" is fairly consistent: They have been
>involved in occupations which have caused biomechanical stress by
>repetitive loading (eg working in laundry) or sustained postures (eg
>keyboard work). Many have possibly predisposing postural deviations eg
>markedly increased cervico- thoracic lordosis, protracted cervical spine
>shoulders anterior and internally rotated ( ? repetitive impingement).
>
>It is difficult to ascertain what happened when or how ie the chicken or
>the egg syndrome. That is, are the poor biomechanics due to pain and
>adaptations or were they pre-existing and accentuated by poor endurance of
>the postural muscles causing stress / microtrauma to the musculo-tendinous
>structures (a possible explanation for trigger points) and neural system
>overload? I agree that the condition is usually multifactorial
>.Clinically I have also found many of these patients to be unresponsive to
>cortsione injection in the long term...if it is multifactorial what would
>you inject? and also often have variable results with MUA.
>
>One factor that has not been discussed but that I think is very important
>clinically is the finding of abnormal neurodynamics. Many of these
>patients seem to have a past history of either insidious onset of neck
>pain; headaches or cervical trauma. The neural component may help to
>explain the development of bilateral symptoms..On examination, they are
>often found to have reduced straight leg raise and commonly on the same
>side as the affected shoulder.
>
>I think that neural mobilisation is very important in the management of
>these patients including working distally and also improvement of postural
>and dynamic biomechanics.
>
>Cervical and thoracic mobilisation may have some benefit in improving the
>neural interface and soft tissue techniques and trigger point work to
>ensure that all interfaces are moving freely to enable freer neural
>mobility.
>
>Di Howell
>Physiotherapist
>Canberra; Australia
>
>PS: The Neuro Orthopaedic Institute have a website which is excellent and
>contact can be made there with Physios at the cutting edge of research in
>this area including David Butler et al. It is well worth a look and a
>bookmark!!!
>
>The address is www.noigroup.com.
---------------------
Stephen Edmondston PT, Adv.Dip.PT(ManTher.), PhD
Senior Lecturer in Physiotherapy
Centre for Musculoskeletal Studies
Department of Surgery
University of Western Australia
Medical Research Building
Royal Perth Hospital
Murray St
Perth WA 6008
AUSTRALIA
[log in to unmask]
http://www.cms.uwa.edu.au
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