Shoulder problem...

[bernard]

Hi somasimplers,

I met a man with a right problem shoulder for months.
ROM is limited and he is not able to perform activaly ULNT.

He said he lost many strength in biceps. It looks like a musculocutaneaous nerve problem for me.

The three bads are present but a pain in front of shoulder stop improvement.

What are your advices?

[Diane]

Clean up all structures that are attached to his scapula...

[rolf]

HiBernard!
I have nt much to go on in thiscase study to help you!?
Which ARM and PRM is most limited.Isometric muscular tests. around the shoulder girdle,what about m.infrapinatus?
Nerve mob.tests for med. rad, and ulnaris ,and palpation of the nerves what do you find?I expect that the neck is out of the discussion!?
Give us something more to go on!
:wink: :wink: :wink:
RIN

[rolf]

Hi Bernard!
Interesting case!How is his gleohumeral joint play!Shoulder rotation out passiv and active?Frozen shoulder in an early stage?When you are palpating his axilla you are able to test muscular tension in subscapularis.At the same time ,when you palpate alittle bit distal to the axilla you are able to feel some of the peripher nerves ,feels like soft or thigh" wires"(n.medianus etc)in the uppper part of the humerus.Compare it to the left side.
RIN :wink: :wink: :wink:

[bernard]

Hi RIN,

Will give some replies tomorow.
Have a nice day.

[bernard]

Hi Rin,

Active external rotation is limited around 55° (creates the spot on front shoulder when reached). Pectoralis major is surely playing there, it is like a wooden rope! Passive is 70°.

Problem occurred in March, so a frozen shoulder is possible?
All muscles of posterior axilla are very tight and do not permit to feel to nerves.

This man has a pain on back, T10 when trying to lift up the arm. It is close to the column and seems muscular. The deep musculature is tight but not very painful when palpating, just when moving.

[rolf]

Hi Bernard!
At the moment Iam working with a women with similar problems.
she have had an shoulder op.,because they thought the pain was due to impingement.It wasent and she didnt get any better.
when i started to inactivate triggerpoints in sm.subscapularis her shouldermovment increased ,active flex 90deg.But now at this range the pain is experienced in front of her shoulder.
she is still hypersensitive/pinfull when palpating her m.subscapularis in her axilla so on moday i will continue deactivate the muscle and see if the m.latissimus aslo have to be deactivated.She is also training(hands of) the rest of her body 2-3 times aweek before she atends to my office.(hands on) :wink: :wink: :wink:
RIN

[bernard]

Hello Rolf,

I had a huge improvement with some somatics and some personal trials, last week.

The somatics exercise is simple. Lying on the floor, arms put aside (horizontal), knees bent and a leg crossed over the other (left over right if right shoulder). You ask to move the legs to the left. The patient is really sensing in the right shoulder and able to move in a better way after 2/3 days (5 movements).

Another one, is easy, standing up, feet a bit aside (40 cm). You ask to cross the fingers behind the back (if possible). And the movement, 5/7 times, is turning the torso to the right but head stay oriented frontward. It removes the front pain.

Just my two cents. They seem very neurodynamics and patients say that they are very comfortable.

[fapt]

Hi Bernard,

Seeing the hx under your demnstration,
How about the patient joint play?
Was it limit?
And how is his end-feel while applying PROM test?

There is some possible disease that the man could be... :oops:

[bernard]

Hi Lin,

Good questions with few answers from my own.
My vision of physiotherapy has evolved to a less restricted way of caring and examination. It seems that we are unable to quantify objectively any ROM since our simple presence interferes with the patients.

I prefer, now, supple movements with harmonious compensations. I do not try to limit/restrict movements.

I added for the fellow some skin/muscular soft actions on angular/rhomboids and he is now returned at work without problem.

There is some possible disease that the man could be...

Could you explain?