Exit forum › Bilateral shoulder restriction/medical side effect
This topic contains 16 replies, has 2 voices, and was last updated by Scott Glidden August 22, 2018 at 7:40 pm.
August 10, 2018 at 12:52 pm #5444
A 73 year old male patient came in reporting of weakness and stiffness in both shoulders. Can’t abduct past 90 degrees. Constant achiness/stiffness that mildly gets better throughout the day. Aches started 3 months ago but the lack of ROM and increase in stiffness started 2 weeks ago. SA: B 90 degrees. Mild adhesion bilaterally on several structures. First treatment yielded 30 degree improvement bilaterally ( I know I shouldn’t do both, but I did).
The following appointment he cancelled and came in later in the week. The day he cancelled he was in the hospital. His MD believes that his Lipitor is reacting with some blood pressure meds and that is causing the problem. All of his gains from last visit were gone. I worked on him again and got some very mild improvement. I told him that if he doesn’t sustain these gains at his next appointment we are going to let the MDs figure out his meds and we will revisit treatment when they think they have it figured out. He has been on these meds for longer than the 3 month period and the amount of adhesion doesn’t line up with how little function he has. Any suggestions?August 11, 2018 at 6:45 am #5445
William Brady, DCParticipant
Do you have a tissue and pathology specific diagnosis? Or have you ruled out tissue pathology?
Sounds like you have ruled out adhesion as being the primary cause of his restriction, due to the fact that adhesion is mild and motion restriction is severe.
Did you test passive and resisted shoulder motion? Did you google lipitor reaction with his blood pressure meds? Statins and calcium channel blockers co-prescription can cause lots of trouble.August 13, 2018 at 10:31 am #5446
He was limited with passive ROM as well as active and he had weakness and pain with supraspinatus press test but they did not fail. I did Codman’s arm drop as well at it was limited, so I told him its likely that as an active 70+ year old man there isn’t much left of the top of his rotator cuff (supraspinatus) and that could also contribute. Lipitor’s side-effects list tenderness and weakness, but I believe these symptoms are beyond that. There is definitely adhesion on the infraspinatus bilaterally and some minor joint capsule/subscap adhesion, but not enough to warrant the low level of function he has. He is still on 2 blood thinners as they don’t believe they contribute to his problems. I’d say it was a partially torn supraspinatus if it wasn’t bilateral and didn’t come on so suddenly, especially with no reported “event” that stirred the pot. With this knowledge I’m confident in telling him we should wait it out after the next appointment if he loses all of his gains again and then go from there. Should I be though?August 14, 2018 at 8:07 am #5447
“Weakness” points at something that isn’t adhesion that is warranting “protective weakness”.
“Passive ROM” being limited points at something structural or joint-related.
Any thought into what those data points are pointing at?August 15, 2018 at 10:50 am #5448
If it were unilateral and not a complete mirror image I would be thinking degenerative tear + advanced arthritis. What are the chances that both of these shoulders happened to develop the same problem at the same time for someone who lives a fairly sedentary lifestyle?August 15, 2018 at 12:08 pm #5449
Seth Schultz, DCParticipant
Have you done any cervical testing or palpation of the nerve roots?August 15, 2018 at 4:49 pm #5450
I haven’t, but it would certainly make sense! I’ll be sure to check them out!August 15, 2018 at 4:49 pm #5451
Carl Nottoli, DCParticipant
Let’s not get ahead of ourselves and just start looking for adhesion to treat. He’s 70 years old so you’re going to find something, but is it relevant?
We still don’t have a tissue and pathology specific diagnosis.
When you did passive abduction how far would the shoulder move (in degrees)?August 15, 2018 at 6:31 pm #5452
Passively he had some mild tension around 110 degrees both sides but was able to get to 150 degrees until it become painful. This is undoubtedly going to be a complex diagnosis but I since I never assessed his scalenes or put him through the nerve tension test, I do think that would be a pertinent data point to get a clearer picture.August 16, 2018 at 7:26 am #5453
In my earlier days on the forum, I’d post data points or ask my questions (I still sometimes do this) and I’d have a more experienced ID provider reach out to me and say:
“Chris, you’re active on the forum and you’re doing good stuff with ID. But if you don’t have a tissue-specific diagnosis, you’re short-cutting the process and therefore, going to make ID life really hard on yourself.”
Carl bringing us back to “What is the tissue-specific diagnosis?” is really important for all of us to continue to make sure we’re discussing before we ask our questions on cases.
Bill doesn’t say this, but I’ll say it here. I wonder how we’d all progress (and if the forum would be more effective) if we weren’t allowed to post on the forum until we outlined:
1st Order hx Points
2nd Order hx Points (that reinforce or not #2)
Then ask our question.
Just some thoughts, Hope you don’t mind my observation.
Can you come up with the diagnosis and we can continue this conversation?
It’s good stuff and you’re using the forum is helping me learn. Thank you.
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