rotator cuff tendonitis

[alophysio]

HI,

I would agree with the above.

I wouldn't friction the calcification but iwould be asking "why is the calcification there?"

HBB no doubt is aggravating the ssp tendon, not likely the subscap tendon.

Forget the GH joint mobes, they won't do much.

Check her serratus anterior status, her upper traps ability vs lev scap overactivity.

I had a patient with bad clacification - it just sat in there and pinched everything that was in the way. Personally i think my patient needs to have it cleared because anything above the head is physically impinged - and i can't do anything about that - it is chronically swollen and sore and a structural limitation - what is your patient's calcification like?

[arifa]

thanks for responses
Her X-Ray shows increased density in region of greater tuberosity, her ultrsound report reckons "soft calcification". No disruption of rotator cuff tendons.
She has no pain at rest, slight pain occurs with active abduction (over 100degrees).
She is able to get HBB to about T10, (T4 on the good side). This problems on going for 7 years. Why do you think GHJ mobs wont work, with the mobs mentioned, it stretches the post capsule.
I really feel quite helpless with her. I've had good responses with similar patients.

Really appreciate your responses.

Thanks guys

[sharileedahl]

I, like you, would tend to mobilize the GH joint too. If not to improve mobility, to assist with some kind of neuromuscular / proprioceptive input (i.e. mobs through range...). I feel it works well when there is impingement.

Do you know what the U/S report really means when it says, "soft calcification" with "no disruption to the r.c. tendons"? Because i'm not sure i really do.
Does it mean that the calcification is lower down on the greater tuberosity and therefore not affecting any area of the capsule? Could it then be affecting the deltoid? I can't imagine there being calcification in the shoulder girdle and it NOT affecting some of the musculature in the area.

However... because her pain seems to be quite mild (and perhaps unlike the pain usually associated with calcification) and comes on late in abduction, I would still look at her pattern of movement. Does she actually impinge? (Hawkin's test / Neer's test?) Does she hike her shoulder at 100 degrees of abd'n? Does the tone in her upper / middle / lower traps change as she goes through range and what happens at 100degrees? Any palpable tight bands in the deltoid or upper traps?

??........

[arifa]

hey there
thanks for your help.
Speeds test was fine for her, empty can produced her pain, hawkins produced her pain. She has a trigger point in upper traps, supraspinatus too (just localised pain on palpation). No winging scapula. no sh hiking through abduction range.
As for her ultrsound report i am not so sure what "soft calcification" means. The report specifically says "increased echogenicity in subscap at musculo-tendinous junction, could represent soft calcification" (same for suprspinatus). Have to assume that the calcification is not so bad, since she does not have any pain at all at rest and only feels it with HBB, feels "discomfort" with writing on board.
The mobs I have been doing are just accessory mobs at GHJ neutral and about 90degrees abduction(short of pain).
I will see her on Thursday and analyse her abduction again.
really appreciate your help