Both shoulders patient !

[emad]

hi all ;

I encountred a patient the day before yesterday,he is 53 man , i do not know what is his problem ,here you are his history ;

He was completely free from eplipsy .
since one week ,has an attack fallen in the ground ,taken to the hospital ,managed as emergency,CT scan revealed nothing as he mentioned ,He stayed in the bed 4 days ,he was not aware of anything .

Then ,he began to return normal ,then felt severe pain of both shoulders ,assessed by an orthopedist ,diagnosed him as biltareal bursitis , gave him intra-articular injection through both shoulders , with no progress , then he visited another orthopedist ,referred him to physiotherapy.

My Evaluation :
Passive movement is free glenohumeral joint .
Active revealed severe pain in any direction espicially internal rotation .

I could not perform any neurodyanamic tests ,because of pain severity .

Any views?


Regards
Emad

[nari]

emad

As much as I'd like to answer, I need more history. This sounds like a severe fall, as you say he was "not aware of anything". Concussion from brain injury?

Bursitis sounds most unlikely as a result so soon after a fall.
What are his neck movements like? And the upper thoracic?
Where does the pain spread to, or is it localised to both shoulders?
Any arm symptoms?
Can he nod and shake his head OK?


Nari

[emad]

Nari ;

You broadened the case ,including brain injury hypothesis , however ,the doctors assessed him as epliptic attack ,because of the signs on the face and mouth of sliving during the attack.

Some of the markers through history ;

No past hisory of hypertension or diabetes.
No headache compaint at all after the attack
no drowsiness feel/complaint at all after the attack
no numbness complaint through whole the body .

examination ;
Cervical is free completely , i tested all movements in all directions , no provocation or referring pain with cervical motions .

During the intial exmination since 2 days , he entered to me walking normal , so that i did not think of brain injury hypothesis.

pain distrubation is bilateral along the lateral upper 1/3 arm aspect .

regards
emad

[Rolf-Inge]

Hi emad!

"Passive movement is free glenohumeral joint ".
But arent you then just doing "nevrodynamics"?

"Active revealed severe pain in any direction espicially internal rotation ".Have you palpated subscapularis deep in his axilla?

I could not perform any neurodyanamic tests ,because of pain severity ."???????

RIN:angel: :angel: :angel:

[Rolf-Inge]

Hi again!

Are there any yellow fags in this history and what about his brething pattern?

RIN

[emad]

Rin ;

His breathing is normal ,breathing ex was my first approach to address that pain .

The passive mtion is free ( no pain ) , but when i tested the passive motion of the GH joint , the patient can not control himself to allow me to apply the movement as passive ,but he shares me with some active .

The pain is so severe ,did not allow me to test as nerodynamic , and i think we are not in need to test neurodynamically at this satge because of the pain severity and stage of the process .

Regards
Ema

[adrian]

You said PROM is WNL. Was PROM tested both laying down and standing/sitting. Sometimes something gets noticed when I do the tests both ways.
adrian

[emad]

Hello Adrian ;
Welcome ,

Yes , i agree with you testing from different positions can give different results , i noticed when i try to assess the shoulder ,different from weight bearing ( i call that because of the gravity , i mean against or with gravity ), from sitting is different from supine .

Regarding this patient , i will try to assess the passive movement in supine position ,because it more appropriate to relax the patient .

Regards
Emad

[Tim]

Hi emad,
It has been a couple of weeks since last comment here. Have you made any other discovery yet into this case?
It makes me think of a patient of many years ago who was a very well-built 35ish man who worked in a lumber mill moving wood. He had no problems until one day nothing particular happened. He just could not raise either hand above shoulder height because of incredibly severe pain in both shoulders.
I was into a lot of MFR back then. First treatment, including arm unwindings did nothing. Next visit I gathered more history and learned he had fractured L5 five years previously. I did a supine dural tube "release". When he got off the table, he could move both shoulders full motion with no pain. I still do not understand what happened, but I am pretty sure of the relationship to the lumbar fracture, years of compensation, and finally an unknown event ("straw that broke the camel's back"). Surely there was a long term development of loss of neural plasticity [hope I'm using that term right] that led to the acute episode.

[emad]

Hello Tim ;

A bit late to reply to your post !

Unfortunately,i did NOT see that patient again ,simply because ,patients in the society or culture where i am living prefer to hear comments from all doctors in the town .

you wrote ;
I did a supine dural tube "release".

Was that MFR technique??

yes, as well strange what you mentioned !

Regards
Emad

[Diane]

Excuse me for a moment Emad,
Re: "supine dural tube release", Tim, do you think that that is
1. what is actually happening;
2. something it may have been suggested to you is happening while you stretch some skin along the posterior body, sacrum/occiput, and/or along spinous processes;
3. might have nothing to do with anything you are doing in any way whatsoever;
4. might be a perceptual fantasy that keeps your mind busy while your hands neuromodulate through skin, until the nervous system self-corrects and motor outflow patterns can de-inhibit themselves.

I'm just curious about how your "deconstruction" is coming along.:D

[Tim]

emad: yes, dural tube release is a MFR technique.

Diane: Of your choices, I like 2, 3, and 4. I use some of the same techniques still, but now look at the neuromodulation through simple contact with skin stretch receptors, sodium ion channels, etc as the beginning of the neural chain. I'll get a little better at explanation, as I "hang-out" here around you neuro gurus. :D