Brendan,
I may not be of help and have more questions than answers (but even
questions can be helpful, I hope), but I am curious about a few things.
Sounds like a number of pathologies rolled into one, although it seems to be
quite common for isolated injuries to the shoulder girdle or cervical spine
to lead to secondary pathologies, makes our jobs more challenging....
1) Any more detail on aggravating and easing factors?
2) Does she have full active range of motion (AROM) of
flexion/abduction/internal rotation/external rotation? How does this compare
to passive ranges (PROM) How does the onset of pain and resistance compare?
(Is external rotation more limited in neutral compared to 45 or 90 degrees
abduction, this appears to be commonly the case in subscapularis tightness
which leads to restricted elevation)
3) Is thoracic spine rom into extension full and does the patient exhibit a
forward head posture?
4) During arom into abduction / flexion, does the onset of pain alter with
contra or ipsilateral cervical side flexion? Are there any other movements
you can use to alter the onset of pain and or restriction?
5) Which resisted tests are painful?
6) What are the glenohumeral accessory movements like?
PREs are progressive resistance exercises (I presume)for the rotator cuff,
from EMG studies these include prone extension, prone horizontal extension
in 90 degrees abduction with the arm externally rotated, elevation in the
plane of the scapula (in IR/ER or neutral)and flexion.
Regards
Steve Aspinall BSc (Hons) GSR
Sport Rehabilitator
Bolton Therapy Centre
Bolton, UK.
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