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To all:
Remember the patient I had who came in with right arm pain but was dx as supraspinatus tendonitis (for those who didn't see it, see below). The doctors believed that PT flared up his condition and hence ceased PT. He has gone back to the Orthopedic surgeon, who has injected cortison into his shoulder joint, and has flared up his condition even more. Now he is back in my care.
He is now complaining of numbness in his right wrist and hand. As well, he says that he is getting very aching thoracic pain with headaches. I did a full examination on the neck, and neck movements are full range but pain at end of range. Palpation and joint play on the cervical and thoraric spine revealed tenderness around the scalenes, SCM, suboccipital, and UTx muscles. As well, his C5-T5 joints were stiff and tender, but also referred numbness onto the right hand. Anterior palpation of the first and second rib was tender, but posterior palpation revealed tenderness and stiffness on the right more than the left.
My PT differential diagnosis at the moment is that he has a nerve root compression on the right cervical spine with accompanying first/second rib "locking" leading to scalene tightness and probably impingement of brachial plexus (axillary nerve). What is your opinion on this matter??
I did some gentle soft tissue mob's on the scalenes and showed him the pendular and stick exercises, but the doctor still believes it is a pure supraspinatus tendonitis with arm pain as a result of trying to compensate(!!). I think this patient has lost all confidence in the 2 doctors who are looking after him. One final question is would you refer this patient back to the doctor for further examinations on the cervical and thoracic spine (such as a MRI or CT scan?? )
Thanks to those who reply this message in advance.
Henry***
>On Wed, 10 Jan 2001 21:08:08 > Henry Tsao wrote: > >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*** > >_________________________________________________________________________ > >Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. > > > > >Get your small business started at Lycos Small Business at http://www.lycos.com/business/mail.html