bilateral shoulder pain

hello friends i m dealing with a patient who developed cervical pivd at c4-c5 ,c5- c6 central disc posterior herniation after heavy wieght lifting 12 years back.than treated conservatively.since than he is having bilateral cliudication like symtoms in both upper limbs as well as shoulder pain.right now claudication like symtoms r cured about 90% but he has having sever morning shoulder pain.he can't perform overhead activities.he feels beeter in evening as the day progresses but same story repeats everyday.i can't find out cause for his soulder joint.is it due to disc problem or separate 1?is there like synovitis?pls add u r opinions and ask if u require more information...

hi
there are some points i want to discuss
shoulder pain can be
nociceptive pain or neuropathic pain
nociceptive pain can be due to somatic structures at the site,refereal from any adjacent somatic structures eg-facetal reference from neck
it also can be visceral refered -eg cardiac in left,liver in right.
there is a need to examine the patient in detail
i suggest to seperately examine the neck and shoulder
signs of thoracic outlet syndrome
neural mechanosensitivity and neurodynamics
as the patient feels better as the day progresses,it mostly wont be mechanical
check the sleeping posture.
noctural pain?
early morning stiffness and pain?
24 hr pattern of pain
severity
irritability
nature of pain?
any specific aggravating movement/activity?
any other associated problems like headache,giddiness?

this patient had disc herniations at C4-C6. This may have affected both the sensory and motor nerves supplying the muscles of the shoulder. Due to this, the patient may have decreased the motion of his shoulder. This can lead to problems such as adhesive capsulitis in which pain in the morning is one of the symptoms.

Please assess for such conditions as the herniations may have led to an alteration in the biomechanical features of the limb.

xplando