Background:
I am a neurologic PT with a minimal amount of orthopedic experience. I just wanted to share my story b/c I want get feedback on what my Ortho doc told me today as my treatment moves forward. I am 35 y/o with no hx of arm injury.

While working with a significantly debilitated MS patient about 7 weeks ago, I strained my biceps, triceps, and a portion of the Wikipedia reference-linkrotator cuff (subscapularis from what my and my PT can best tell). Well, no diagnostic testing was done, I was referred to OP PT with official diagnosis (from the occupational medicine doctor at my hospital) of "biceps/triceps strain". In case you're wondering how I strained opposing muscles, it was simply a case of maximum isometric cocontraction while I tried to keep this poor woman from pushing herself (and me!) on to the floor.

Anyway, I had formal therapy for about 5 weeks with mixed results. The triceps seems pretty resolved, I still have very mild subscapularis pain at insertion. What is most troubling to me and my therapist is the lack of progress with the biceps. This was always my worst pain. I have regained full ROM with little to no pain but can't lift more than about a pound or tolerate yellow t-band exercises without pain. I've had iontophoresis, kinesiotaping, daily ice, and BID naproxen for to help control inflammation. I returned to the MD and reported my persistent biceps pain. I implored her to order an Wikipedia reference-linkMRI, almost positive that I had to have a minor tear that just couldn't heal. An MRI was done 3 days ago and was looked at by 2 different radiologists who both agreed that the tendon was intact, including at the musculotendinous junction where my worst pain is. There is little to no local edema and no major scarring.
The Orthopedic specialist (very prominent and works with major league baseball players frequently, so I trust his opinion) told me today that its just a bad strain and that when these occur at the MTJ they tend to take a long, long time to heal. He encouraged me to plug away, confident that my tendon is intact. He told me to let the pain be my guide and continue use of ionto and/or naproxen if I think its helping me to tolerate treatment. He also encouraged me to have Active Release Techniques done if my therapist was skilled in it. (I don't know much about this)

So, I ask you: Does this sound like a plan going forward? What ever happened to exercise in a pain free range or exercise progression once pain free tolerance is established? Again, I'm not an orthopedic therapist but I just don't want to push too hard...or not enough. Any other interventions you can think of?

Did I mention that I'm still working full time? I'm limited to patients that require min assist or less as a precaution. But its kind of a pain in the #$% for me and my staff to work around.

Thanks in advance for your feedback!
I'm fairly new to the board and look forward to giving some of my own in areas I think I can contribute.

Jeremy

Similar Threads: