This topic contains 3 replies, has 1 voice, and was last updated by Christopher Stepien October 30, 2018 at 10:24 am.
October 29, 2018 at 3:56 am #4862
Knowing that one of my biggest downfalls in the past has been to squeeze glenohumeral abduction test I would like to check in with a case I want to take on and making the same mistakes again..! This gentleman is
- R Shoulder (points at the anterior delt over the biceps tendon)
- Hurts with shoulder movements like turning a large valve on and off (think a school bus wheel) and carrying heavy objects with that arm.
- Feels better with rest and avoiding doing the irritating movements/activities
- feels dull and achy with a bit more intense with some movements
I will attach a photo of the offending GHAbd
My problem here is that during the motion he seriously elevates his GHJs and it gets quite difficult (hard) to pull up. There is a pain in his Superior joint line that starts at about 165d and maintains all the way to the top. As you’ll see he “makes full range” biceps to ears but I think he fails because he is compensating like crazy and it hurts. I’m not “squeezing the test” am I?
Attachments:You must be logged in to view attached files.October 29, 2018 at 8:04 am #4865
William Brady, DCParticipant
His range is good while symptoms with load persists. The next step is to perform resisted testing of the supra and infra. If this reproduces his symptoms then the odds of a rotator cuff tendon tear with inflammation goes way up.October 29, 2018 at 9:56 pm #4866
Thank you for the reply.
I did test resisted internal, external rotation, biceps, flexion, extension and abduction and non really caused any pain. Some minor discomfort but certainly no smoking gun. Empty can -ve, and abduction just off the side also -ve.
I might actually video the way he does this GHAbd when I see him next and see if I can post that so you guys can see what I’m seeing.
It does sound like you are saying Dr Brady that to apply manual therapy here may be a fools errant?
Right at the moment my best Dx list is
1. Mild/moderate cartilage damage
2. Adhesion (moderate) (palpated infra, teres and subscap)October 30, 2018 at 10:24 am #4867
Yes Michael, Bill is saying more manual therapy won’t be helpful.
I sometimes forget the 3 treatment rule – we need to see progrewss.
If his range isn’t improving in 3 treatments, he’s either over-loading it OR further treatment won’t make a difference (because the adhesion isn’t relevant).
Load management and strengthening would be in order.
If he’s not reality-matching and overloading his shoulder through choice, an arthrogram (if you suspect labrum) to help him make better choices given the damage.
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