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 overrotator 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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