hi all
Need help with a patient that i have been treating for more than seven sessions.
She is a 50 year old school teacher presenting with shoulder pain for the last 6 years, aggravated last couple of months. Subjectively pain not there at rest but comes on with hand behind back(HBB). On assessment she has a positive empty can test, limitation with HBB, pain from about 100 degreess abduction. Cervical movements fine and pain free.
My treatment has entailed shoulder mobs specifically GHJ A-P's in neutral, GHJ longitudinal caudad grIII. cross frictions over Wikipedia reference-linkrotator cuff tendons, posterior and inferior capsule release(soft tissue work) trigger point therapy over upper traps, supraspinatus. Have had very little improvement with HBB. The last session i gave her external rotation exercise with theraband with shoulder in neutral position.
Improvement has not been significant at all.
I sent her for an u/s, results came back showing calcification at musculo-tendinous junction of subscap and supraspinatus. Infraspinatus is fine, biceps longhead is fine.

Next step would be referral to ortho specialist. Throughout treatment she has been on anti- inflamm drugs. Any suggestions? I am possibly missing something?

look forward to responses.

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