Complex Case

[bhawna]

Hi There,

I have a case. One of my friend is suffering from so many illness..He is 25 years old...Like he is having a back pain, cervical pain and shoulder pain. Actually the case is some 4 years back he started with back pain , He was working and suddenly he holded some 200 kg weight for a spur of time and because of that his back pain is started. He showed himself to the orthopedics and diagnosed as Prolapsed intervertebral disc at L4-L5 and L5-S1 and also lumabar canal stenosis. He is having so many tender areas and pain.

Second is He is having left shoulder pain as well. His range is around 120*(now) and he is having a radiating pain..which radiates in uppeer arm, to the sternoclavicular joint, and scapula medial border. he is having tender areas in shoulder, sternoclavicular joint and at the scapular area as well.He showed himself to the doctor and he is diagnosed as SLAP tear.

Thirldy, he is having neck pain as well..I am not sure what is the reason behind neck pain..That might be because of the bad posture and of course that bad posture is because of back pain and shoulder pain..He is not able to lie supine,neither prone nor side lying...

This is the whole information about the case.

What i started on him is ..I picked his shoulder and started mobilisations and astive resisted exercises..rest is still un touched...

what u all suggest me to do...I dont have any electrotherapeutic equipments with me.
Thats all

[emad]

Hi Bh;

Welcome here ;

I think you do not need any electro ,you just need your friend to be checked first by a cardilogist to rule out any hypothesis related to his work !however,you mentioned that he experiences that pain for 4 years ,that is enough to rule out that.

If it is sure the whole issue is musceloskeletal hypothesis ,he needs rest and just gentle fine movements .

I do not agree with resisted or stretching espicially ,if there is pain .

Best Regards
Emad

[bhawna]

See he went to cardiologist as well..He is not havind cardiac problem..Secondly, i am giving mobilisations on shoulder..'coz i m skeptical about frozen shoulder. He is having back pain for the last 3-4 years and that too is traumatic.I am not working on Back.I am working on Shoulder.

[emad]

What is meaning of COZ ???
What is the SLAP tear ?
What is his job ?

Why did you choose to begin to mange this complex patient by ( pick his shoulder )

Regards
Emad

[bhawna]

COZ is because...I am sorry this is the short term for because.
Secondly, SLAP tear is superior labrum anterio posterior tear. His left side is the dominant side and the affected shoulder is also left. He is a mechanical engineer. I took shoulder first because i believe that the pathology in the shoulder is just now started and it will be better to treat shoulder first..Secondly, His back pain is chronic and it is painig for the last 3-4 years where is shoulder pain is from the last 2 months.Thats why i chose shoulder first.

[rajulvasa]

What about Collagen disorder like Ankylosing Spondilitis?
Is it ruled out?
Is the Test for collagen disorder done?

[nari]

Bhwana

Certainly conditions like collagen disorders would need to be ruled out.

But 200 kg is a heck of a sudden stress on tissues. Did the doctor do investigations to come up with the SLAP diagnosis? If not, then the shoulder is probably part of the whole spinal dysfunction.

This fellow is in the grip of chronic pain, and it may not matter about the individual areas - neck, shoulder, spine can all have the same origin: an abnormal mechanical stress from the injury.

Strengthening and particularly resisted strengthening may worsen matters. Force applied to tissues which have already undergone considerable force stresses may aggravate. Slow movements are worth trying. Neurodynamic movements may help, so let us know if you know about them.

What is his least painful position? If you can find that and work slowly from there, just simple slow movements and assure him that the pain will not damage him, it might help. It doesn't have to be the traditional flex, extend, abduct stuff...ask him to move any way he would like to.
Avoid passive work: it does not really tell the brain anything much.

Nari

[bhawna]

I don't know neurodynamic movements. I wonder if u help me out in knowing that.

Secondly about that weight , he holded that somewhat 3-4 years ago and that too for a spur of second..Kind of reflex action.But yes that definitely hurted his back. But the shoulder and neck pain is just started..some what 1-2 months ago and i dont think that this is because of holding that weight.

More over , no test for collagen injury was done. I stopped giving him strengthening exercises.Do u think mobilisations will work? He usually do active exercies like wall exercises , pedular exercises and so on. Yes doctors did the neccessary test to say that it is a slsp tear..He as well undergo EMG and its shows correct results.

About the least painful position..what should i say??? Actually the situation is like this...his left shoulder pains andin the back he is having tender areas..on the right lateral side of back.so he cannot lie on left side because of pain in lt shoulder and cannot lie on right because of back. Prone is not the recommended position and more over if he lie down prone..his neck started paining and he lie on supine..still his back pains.Because of all this , He is not able to lie for more than 2-3 hours , after that he usually get up and moreover he cannot sleep because of pain

Actually he showed himself to the orthopedic doctor and he said ..the only treatment is to undergo spinal surgery..But i am quiet skeptical about the surgery..I mean at the age of 25, surgey won't be a good decision as there are 50-50 chances of getting paralysed or something

what you say now and please let me know about the neurodynamic movements.

I really appreciated your help.

Regards
Bhawna

[emad]

Hi Bhaw;

you need to ask him stop all those ex/activities ,he is doing as treatement ,espicially motions that evoke more pain ,of course ex repitation as you described flares up pain .

The story of neurodynamics is long ,if you have not heared about yet ,you do not need all the background now .you just need the following ;

#Deep Breathing ex 4 times
#assuring the patient
#Stop all and most activities whgich evoke the pain
#http://www.somasimple.com/forums/showthread.php?t=2039&highlight=Upper+Quadrant
#http://www.somasimple.com/forums/showthread.php?t=792


Please ,take a look at at somasimple subsectcion try it or lose it .

Regards
Emad

[bhawna]

Thanks emad

I will ask my friend to do these two exercises. I hope it will help him. Actually, he cannot avoid the activities. Like regularly , he drive for 2 hours/day..he cannot ignore driving..as his job place is 35 miles away.and that also hurt his back..sometimes , he drive for 4-5 hours. That make his back stiff.

I asked him to do a little for massage with soft hands..Is that helpful??

Today i wll ask him do those two exercises.

Thanks once again for your help

Bhawna

[emad]

Hello Bah again ;

Regarding ,massage and touch of the painful areas/points ,i do not support to do that by himself because simply thus will be done in non-experienced way , i think if he pressurizes those areas so hard thus could evoke pain ,this is my view ,however ,here on somasimple there are other members have great interest and experience in practising touch for pain .

Regards
Emad

[nari]

Bhwana

If you are not at all familiar with neurodynamics, don't worry about it - they take quite a while to learn about and do properly.
I would follow the suggestions in emad's post above.

nari