shoulder pain

[monak84]

Hi,
I would like some advice about this patient.
Female patient,35yrs of age,was working as a labourer but has quit her job 4yrs ago.Does only housework presently.She has been complaining about pain over the right shoulder radiating to her elbow.No history of fall or trauma.ROM is restricted due to pain.
Tenderness over ant.aspect of shoulder.She has got severe trapezius spasm,but has been relieved to quite an extent aftr MFR(myofascial release) and SSF(strong surged faradic current).

Cervical n shoulder xrays are normal.

She took ultrasound for around 5days bt no relief.

The MRI report -supraspinatus n bicipital tendonitis.

i wanted to know,how would u diagnose the condition without an MRI n wat treatment would u suggest.

thank u.

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[physiobob]

Hi there Monak84. Although there is some tendonitis in the biceps tendon we must be able to account for why this would be the case if we want to suggest that it is actually the cause of the pain. And overactive upper trapezius suggests this is not this issue and that this finding might well be secondary at best.

I would look at possible accessory mm activity and an elevated first rib. Release the subscapularis under the axilla, perhaps mobilise the AC joint through and at end of range and generally check the movement of the scapula on the thoracic spine. This is most important for any should problem that you find. A tight, kyphotic thoracic spine that cannot extend will always lead to shoulder issues. But remember the symptom is not necessarily the casue. Look for the "Sign".

Let us know what you find. p.s. Today we will enable uploading of file along with posts to this system. We will restrict the size of the attachements but this will permit uploading of image files such as x-rays and also clinical protocols and guidelines

[arunja]

Dear Friend,

I would like to comment about your patient with shoulder pain. My humble advice is that please check for the dermatomal distribution. Check for the C4 and C5 nerve roots. Check the nerve tension , use neurodynamic principles , there may be a chance of compromise of the nerve in its course . It may be also due to the trapezitis.

Or the condition may be related to cacification of tendons of Bisceps and supraspinnatus (as you mentioned). Try some of the special tests with resistance . If so you have to make him do a lot of physical activities and also ex' s with pulley's in all directions.

This was my hypothesis of that condition and if you feel any difficulty in my discussion please ignore it. Thankyou ...

[monak84]

Thanks for ur advise

Mona

[sdkashif]

Have a look over this useful article for detail

Evidence based clinical Guidelines for Diagnosis, assessment and physiotherapy management of Shoulder Impingement syndrome