Erik, palpate his suboccipital muscles and the C1/C2 dorsal roots; if he
feels them tender and you feel them taut, he may have suffered as well, UpC
subluxations requiring correction so the GNN can do its distal "thing". If
he presents with so much finding in the upper extremity, those damaging
forces must have impacted the upper cervical spine by mere dispersal of
forces.
T.
-----Original Message-----
From: Erik Goossens <[log in to unmask]>
To: [log in to unmask] <>
Date: Monday, October 04, 1999 7:39 AM
Subject: Subluxation with a special touch...
>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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