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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