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49 YO female with neck and right shoulder pain

Exit forum ID Forum Discussion 49 YO female with neck and right shoulder pain

This topic contains 0 replies, has 1 voice, and was last updated by  Anonymous January 10, 2018 at 1:47 pm.

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    Anonymous

      49 yo female presents with right ant shoulder and bicep area pain that feels like a 50lb weight is on her arm, right posterior neck pain and suprascapular pain. Shoulder pain is worst, longer in duration and the priority.

      Both are chronic and have been hurting her for years. Her shoulder has been hurting her for almost twenty years.

      Previous history- rotator cuff surgery 2001, can’t remember which muscle. did not resolve with surgery. Carpal tunnel surgery last year for numbness from elbow to hand, 80% improvement after surgery.

      Provacative- Activity with arms stretched outward, raising arm above head, pulling pillow out of pillow case, driving, putting on jacket, sleeping on it at night.

      Palliative- letting arm hang down, holding arm to side.

      Quality- feels like 50lb weight on arm, burning pain

      Severity- everyday 5/10, at worst 9/10

      Exam:

      SA R 140 degrees with 8/10 pain, she wants to drop this arm down as soon as she reaches end range. Adhesion of infra, teres min, entrapement of NVB at subscap (palpation caused sx in R arm),

      UCF 10 no pain, mod adhesion, no pain

      C/S flex- 31 mod pain, mod adhesion B/L

      CT flex-42 no pain, mod adh at accessory nerves, ct erectors

      Rotation L 62 degrees, R 57 degrees mild to mod pain BL

      I diagnosed with degeneration in R shoulder, Adhesion of shoulder muscles listed above, degeneration in C/S and related adhesion.

      Tx began on shoulder and first two visits got ROM to 162 degrees with no change in sx. I treated for 4 more visits with no more change in ROM or Sx. Subscap proved to be very difficult to treat because protective tension would kick in before tension on the entrapment happened, same with inf. capsule.

      Being at the end of the year I advised her that we needed to get an MRI on the shoulder and we would do so in January and we switched to neck then. Current neck measurements are UCF 16, CSF 42, CT 52. We are currently treating nuchal lig and C/S erectors.

      MRI of the shoulder came back and there is stuff everywhere:

      Mild supraspinatus tendinosis

      Low-grade partial thickness articular surface and interstitial tearing of post/distal supraspinatus and anterior distal infraspinatus

      trace fluid in subacromial bursa

      Mild calcific tenodonitis of supraspinatus and infraspinatus

      So I am making slow, but good progress in C/S, progress has stopped with MAR in the R shoulder, and she has a ton of degeneration in her shoulder. She also very likely has a ton in her neck.

      My questions:

      What do I do with the shoulder ? I don’t know if strengthening would go over well in the this shoulder, eccentric exercises for tendonosis?. It doesn’t seem surgical, but is a referral warranted?

      Since her shoulder is so bad, should I follow up with imaging of the C/S?

      How do I communicate and further manage this patient’s degeneration and irreducible blocks.

      Thanks and let me know if you have any questions, thanks.

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