Hi Pt-world,
I have a somehow special case to introduce : any thoughts on further
strategies are welcome !
- Male, born 1966, Ht. 1m70, Wt. 70 kg, working as a service engineer
for a plumbing company was involved in a car accident : while he hit
another car, a hardware-box thrusted forwards in his car, hit his right
shoulder P/A, causing following conditions :
-Shoulder subluxation (10.05.99) with labium-rupture and sensory
plexus-laesion.
Gattered data on Sep. 28, 1999: (yes, that long after injury...)
- light swelling of Deltoid pars ventr. area (worsening through
Mobilisation)
- no visual muscle-atrophy
- Mobility Status : active elev = abd only max. 90° : Patient has
strong Pain end ROM ventral area as above and produces compensatory
movement (Upper Thor.)
Passive mobility : elev. 130° with 'empty' end ROM feeling (Pain & Pat
shows resistance to Motion)
Pass. abd. 110° with same conditions as in elev.
add. and rotations are normal
After active and/or passive motion : loss of sensation in entire arm
Questions :
- Loose body ? (no moving pain in GH Articulation though...)
- Why is it that in a plexus-laesion (or partial plexus laesion) ONLY
the sensory components can be involved ?
- Are we looking at a secondary pain state ? With abnormal findings ?
(I'm sending this post also to the people of NOIgroup.com, David
Buttler, Louis Gifford and other bright minds with good concepts on
Chronic Pain systems...)
- Any good ideas on treatment strategy : we've tried cooling agents,
must be very carefull with modalities because of the sensory
involvement, any active forms of therapy seems to be worsening the
picture...Working on the thorax, scapula and clavicula is being done but
not very rewarding : and this guy really wants to get forward, just got
married and loves his job and leading an active life ! I don't feel too
confident in bringing him in our reconditioning section when he still is
in such a pain status...
Thanks for your thoughts...
--
Erik Goossens
Dipl. PT SRK - PT Educator Akad. TvdL Landquart
Physiotherapie Erik Goossens GmbH
MediFIT Medical Reconditioning
CH-4102 Binningen - Switzerland
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