Shoulder pain

[wkyagnes]

I wish someone can help me the below case:
I had a patient complaining of a gradual onest of left shoulder pain about 2-4 months due to a recent increase activities in daily life, or being active in her daily left after all the radiotherapy.

PMH: Breast lumpectomy on left, lymph node removal on left, hysterpectomy. Radiotherapy for 6 week.
History of occassional neck stiffness and pain, usually settled with chiropactor treatment.
Medication: Arcuxlex? (not sure the spelling)
Arggrvates by lifting things with left hand, sleeping on both left and right side, takng off clothes and swimming esp. in bring arms from back to front in breast stroke.
Ease: Avoid those movement.
She has a kyphotic upper back posture, her head and bilateral shoulders has displaced forward.
Upper trap is very tight, and her scapulae are wining on both left and right side.
I have check her neck movements, movement are slightly stiff, LSF increase pain on left, RSF and R ROt givining her a pulling sensation on left.
on pallpation, C3-T2 are stiff and tender.
AROM on left shoulder are painful in Flexion 90, abduction 90 , ER (90) 60. Other AROm are not restricted. PROM of flexion, abduction and ER (90) are painfree and full range.
Open and empty can test are painful and weak, Gd 4+; Speed test is painful and Gd 4+, Left off test is painfree and weak Gd 4. Palpation on biceps tendon is slightly tender. No tenderness is felt on other rotator cuffs.
She has a reverse GH rhythm in flexion and abduction movement.
Compression and distraction of GHJ are painfree. Patient felt a slight pull in inferior glide and AP of GH at abduction 90.

May i know anyone has any idea of what sort of problem that she has? Any suggest on the treatment approach?
Many thanks.

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[alophysio]

My bet is on impingment since passive movements are ok (excludes frozen shoulder) and you rate her RC at Grade 4+ (excludes RC tear).

[somasimple]

Hi, I replied there =>
www.somasimple.com/forums/showthread.php?p=8929

[Physiobase]

Then post it here Bernard!

[somasimple]

But she asked there too!

Hello wkyagnes and welcome to the site,

Well, a typical case of breast cancer and its surgical intensive/extensive treatment.

Imagine it happened to you! What would be your expectations, toughts and future? I'll be certainly distressed, for sure. Here she is!

Use a soft approach with breathing and use lower limb to move gently the torso and painful areas.
a bit like this =>
www.somasimple.com/forums/showthread.php?t=792
www.somasimple.com/forums/showthread.php?t=794

Forget for a while a direct, agressive approach of the site but use indirect ways to mobilize the zone. It is ever better to focuse early stage on torso prior to shoulders.

Gook luck and give us some news about her.

[wkyagnes]

Dear All,
Thanks for the reply.
I think lots of people view both somasimpler and physiobase....I dun mind if anyone gives me answer on either web site.
Many thanks.
How come there are so many nice physio web sites in Aus?
:rollin

[Physiobase]

Highly competitive market place