Beautiful post. Lots of great info and wise suggestions
I agree!
Noemi
-----Original Message-----
From: Paul Sumner <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 11 January 2001 14:29
Subject: Re: supraspinatus tendonitis
Personally, i would say this chap appears to indicate more of a neural
hyperalgesia / possible impairement than a straight forward local
tendinitis. 3 months and his injured tendon is pretty much healed. His pain
therefore is considered non adaptive and more than likely the MRI scan
showing a partial ruptured s/s could well be a red herring. Treating the
symptoms as a hyperalgesia, probable nerve root would account for the
exacerbation of symptoms. Recent work by Devor & Seltzer: pathophysiology of
damaged nerves in relation to chronic pain. In Wall, Melzack The textbook
of pain 4 ed Churchill livingstone, shows how a switch on of normally
dormant ion channels during nerve damage or over use can create extreme
sensitivity in normal tissue.
Personally i would keep my hands off! Educating the patient on pain
mechanics and preventing any unnecessary fears would be a start,Carefully
assess the neuro muscular endurance through for eg. repeated bicep
curls(C5,6) and compare to the other side. Then send the patient home
working any deficit well within what is comfortable eg. 10 bicep curls lead
to symptoms then start off by carrying out 5. Gentle pendullar swings for
neural mobility.
Hope this can be of some help Look up www.achesandpainsonline.com
for a great web site and related articles/books.
Regards
paul sumner Cornwall,uk
>>> Henry Tsao <[log in to unmask]> 01/11/01 02:29AM >>>
Elmer,
Thanks for the advice, and I will keep this in mind next time. Due to the
fact that his right shoulder was so sore and the fact that he was going back
to see the doctor today, I elected to have a look at the shoulder and treat
it as the doctor ordered.
He returned today and presented to me with an acute wry neck, with numbness
in the right hand and dull ache down the right arm. On neuro exam:
- C4-6 dermatomal sensation was reduced and corresponding muscle strength
decreased(however, he had pain with muscle strength testing, so this could
be a false positive).
-BJ and TJ were fine
Also, his C4-C6 facet joints referred his pain. I did some manual traction
today plus gentle mobilisations, and this has corrected his posture.
However, he still had very restricted neck movements. What I am still
wondering is what exactly I did yesterday that had made him worse... I have
also passed these findings to the doctor and the orthopaedic surgeon.
Henry***
>Henry:
>
>A thorough evaluation and examination
>is indicated here - with the exam
>starting from the neck down. When dealing
>with shoulders you should routinely examine
>the neck and proceed accordingly based on your
>findings.
>
>Elmer Platz, PT
>418 Route 515
>Vernon, NJ 07462-3027
>(973) 764-6136
>(973) 764-4515 fax
>http://www.platzpt.com
>
>"Every man owes part of his time and money to the business or industry in
>which he is engaged. No man has the moral right to withhold his support
>from
>an organization that is striving to improve conditions within his sphere."
> President Theodore Roosevelt
>
>
>-----Original Message-----
>From: PHYSIO - for physiotherapists in education and practice
>[mailto:[log in to unmask]]On Behalf Of Henry Tsao
>Sent: Wednesday, January 10, 2001 4:08 PM
>To: [log in to unmask]
>Subject: supraspinatus tendonitis
>
>
>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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