> Steve,
> Thanks very much for the time you have spent to help me with this patient.
> Here is the additional information......
>
> 1) Any more detail on aggravating and easing factors?
> Eases: rest, hand held supported across abdomen, taping into shoulder
> retraction and elevation. Positions provide almost instant relief from
> infra-clavicular pain but an ache remains in the shoulder joint area.
> Aggravating: most aggravating action is 'shoulder shrugging' which pulls
> through behind the clavicle, also carrying objects, pushing and pulling
> doors and turning the steering wheel aggravate the pain.
>
> 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)....Right Shoulder
> ACTIVE ROM: (P1 and R1 are initial onsets of pain and resistance
> respectively)
> Flexion: 95deg P1 infra-clavicular pain and posterior shoulder
> Extension: Full ROM no pain (R=L)
> Abduction: 135deg P1 infra-clavicular pain (movement pattern includes
> scap depression!)
> External Rotation: 85deg P1 infra and supra-clavicular pain (R 10deg <
> L)
> Internal Rotation (HBB): T7 P1 supra-clavicular pain (L=T3)
>
> PASSIVE ROM: (P1 and R1 are initial onsets of pain and resistance
> respectively)
> Flexion: 95deg P1 infra-clavicular pain. (*****No change with Cx
> sideflexion)
> Extension: Full ROM no pain (R=L)
> Abduction: 100deg P1 infra-clavicular pain, 'pull' in axilla and medial
> arm
> *****with contralat Cx rotation: 70deg P1 same pain area!*****
> External Rotation: 85deg P1 infra and supra-clavicular pull. No
> difference in range when tested in abduction (Subscap).
> Internal Rotation (HBB): T7 P1 supra-clavicular pain (L=T3)
>
> 3) Is thoracic spine rom into extension full and does the patient exhibit
> a
> forward head posture?
> This patient is posturally quite kyphotic through the thoracic region but
> has full thoracic extension ROM.
>
> 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?
> See part two*****
>
> 5) Which resisted tests are painful? nil!!! (So I guess PRE's will only be
> of use for postural re-education.)
>
> 6) What are the glenohumeral accessory movements like?
> a) P-A and A-P GH joint glides are stiff compared to the left but she
> tells me that her shoulder has felt stiff following the first episode of
> shoulder pain.
> b) Interesting, in standing, passively elevating the shoulder+ girdle
> through a force applied only through the elbow leads to sharp shoulder
> pain but isolated cephlad compression of the GH joint does not lead to
> pain. hmmmmm....another pathology?
> c) AC joint shears cause pain in the anterior shoulder joint but I feel
> this may be due to hand pressure.
>
> Many thanks again,
> Brendan Valente
> (A/Senior Physiotherapist)
> Physiotherapy Department
> Fremantle Hospital
> Western Australia
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