HELP! my shoulder stucked like 'OLD GEAR BOX'!!!

[jacinta]

yes, you are reading what my patient complaining exactly.

yesterday a pt. came to my dept c/o as above.
He had his Lt. Rotator Cuff repaired 2/12 ago.
this gentleman was active in sports , particularly tennis until he had his RC repair.
he attended rehab since ops, stopped coming for 1/12 d/t away for work.
Pain inferior to Lt. scapula spine didn't seem to resolve.
loud crepts noted on initiation of all shd movement, especially IR and ER.
gradually unheard as more repetitions performed.

on observation, Scapulohumeral rhythm had been restored as compared to previous.
Lt rhomboids and Serratus anterior activation is good.
All movement AFROM, no ERP.

pt c/o Lt shd occacionally(unpredictably) stucked when attemp to lift up in abduction. when attempted abduction in supine, the Lt. shd stucked badly.
pain increased +++.

palpation reveals that his infraspinatus had fibroused.
Lt. RC tendon hardening.

there are many points that i dont understand.
is the 'stuck' d/t the fibrousis of his infraspinatus muscle and hardened RC
that lead to congestion of his GH joint space,
hence as the movement initiated, friction occured and loud crepitus produced??
therefore, translation of humeral head is not smooth d/t strutural dysfunction? or is it coupling force imbalance?
but, how does all these linked to the 'stucking' of his left shoulder?

please guide me. thanks a lot.

* his shoulder pain had been thr for about 6 yrs.
* constantly keep up with exercises daily.

jacinta

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[Hunter_PT]

I may actually post an answer if you would use decent abbreviations. sorry. you lost me.

[Canuck Physio]

lol, they are discernable with some effort.

[jacinta]

hi hunter,

if u are discomfort with what my pt complaint,
well, sorry i cant help, if it turned u off.
I dont find him wrong to be expressive.
anyway, thanks for ur reply. appreciate that.
Will try to seek answer elsewhere.

jacinta

[Hunter_PT]

Jacinta...

i wasn't saying your patient's concerns or expressiveness weren't important. I was just having a hard time deciphering what you were saying with your abbreviations. I wasn't trying to blow off your concerns. Just write what you're saying clearly and I will try to help

[jacinta]

Hi Hunter,

of all that I dont understand is that,
apart than the fibroused infraspinatus,
his shoulder has muscle strength of 5/5, all movement are in AFROM,
what could have lead to his problem?

jacinta

[Hunter_PT]

The only thing I can think of without giving it too much thought is Snapping Scapula Syndrome, (1) when the soft tissues between the scapula and chest wall become inflamed or fibroused or (2) the mucle have atrophied and the scapula is riding more closely to the rib cage and bumps or rubs on the ribs during movement. Also, when a possibly fractured is misaligned rib or scapula isn't lined up appropriately it can cause a grinding or snapping asss the scapula moves over the thoracic wall.

You may try:
1. strengthening serratus anterior, infraspinatus.
2. Postural re-education
3. Scapular release of infraspinatus especially since you say yourself it is fibroused.
4. Test thoracic mobility

There are quite a few other things but this is it for now since i've gotta head off to work. Peace chief

[jacinta]

hi hunter,

thanks so much for the info.
your sugesstions 1 -3 were done since earlier treatment.
but i completely miss out thoracic mobility and strengthening infraspinatus.
will wait and see if his symptom ease off after restoring the muscle strength.

jacinta