Henry, What about first rib restriction, which can lead to or be due to
scaleneus anterior tightness, and will be noticed on deep insriration.
Try first rib glide, ant. or post., with shoulder abduction. This is just
a hunch, having read your initial problem and other replies. The MRI is
probably irrelevant, so far down the track. The incidence of SST
degeneration that is asymptomatic suggests this.
Cheers, Martin Kidd.
----------
> From: Henry Tsao <[log in to unmask]>
> To: [log in to unmask]
> Subject: supraspinatus tendonitis
> Date: Thursday, 11 January 2001 10:08
>
> To all:
>
> I had a patient come in yesterday with the diagnosis of supraspinatus
> tendonitis in the right shoulder. November last year, he was pulling a
one
> tonne tray out of a truck, and when it was jammed, he forcefully pulled
it
> backwards using both his arms and body weight, and has had pain in the
right
> upper trapezius/supraspinatus/supraspinatus tendon regions ever since. He
> has been on light duties at work, and has had no other treatment apart
from
> anti-inflammatories and rest. He also complains of pins and needles in
the
> right deltoid region, and has had associated right sided neck pain which
> increases with movement. He stated also that his pain in the
supraspinatus
> tendon region increased with deep inspiration. His elbow and wrist was
fine,
> and general health was fine.
>
> He had an US on the right shoulder which revealed partial tear in the
> supraspinatus tendon.
>
> He has been to a orthopaedic surgeon, who diagnosed it as supraspinatus
> tendonitis. He presented with the following on examination:
>
> - very depressed right shoulder with atrophy of surrounding scapula
muscles
> (which was different because I would have expected him to have a more
> elevated shoulder on the right side)
> - tenderness on palpation of upper trapezius, levator scaplae, supra and
> infra spinatus and supraspinatus tendon.
> - both shoulder abduction and flexionpain at ~60-90; unable to elevate
past
> 90; no scapula movement was visible with shoulder abduction.
> - painful A/C and G/H mob's.
>
>
> Due to time restrictions, I did not examine any further. I treated him
using
> low grade A/C and G/H mob's, U/S of his right supraspinatus tendon, and
gave
> him pendular exercises to do.
>
> He went home and immediatedly called me telling me that he felt a real
> heaviness on the right shoulder and was unable to lift it. I told him to
> come in the today. What I am suspecting is compression of the peripheral
> nerves, and I will do a neuro exam on him today. Does anybody have any
> suggestions on what else could be happening, and what I may need to be
> careful of?? Also, has anybody seen supraspinatus tendonitis with
associated
> right shoulder depression?? Thank you in advance.
>
> Henry***
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