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Pain Arcs & Sensitivity to Pain-Generating Tissues in MRI? [AC Jt OA]

Exit forum ID Forum Discussion Pain Arcs & Sensitivity to Pain-Generating Tissues in MRI? [AC Jt OA]

This topic contains 4 replies, has 2 voices, and was last updated by   Christopher Stepien October 18, 2017 at 8:24 am.

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    Christopher Stepien

      I have a 33 year-old male patient with a pain arc. I suspected a SOL and got an arthrogram. The only finding was “Mild AC Joint OA”. I called the reading radiologist to double-check and he looked over all relevant tissue – didn’t find anything. I looked at it and didn’t find anything.

      This is the first time I’ve sent someone for an image without coming back with a more positive finding.


      1. Bill – What is the % sensitivity (I’m sure you’ll make this up – I’m looking for the # in your head) as far as “pain arcs” and imaging findings?

      2. Bill/Everyone – Can AC joint OA cause a “pain arc”? I don’t understand what would be getting caught and slipping by?

      3. Everyone – Have you had a “pain arc” with no positive findings on arthrogram in the shoulder?


      Carl Nottoli, DC

        I would suspect a bad AC joint could cause a painful arc as the AC joint does compress with shoulder abduction. The clavicle then rocks posterior/inferior so may be getting out of the way of the degenerative spot.

        What are the other 7 history order tests for this patient? What were the exam findings? Definitely an outlier type of case. I don’t recall seeing something like this before.


        Christopher Stepien

          Thanks for input Carl.

          1st Order Hx Points:

          1. Male
          2. age 34
          3. Left superior GH joint
          4. ache/throb
          5. 8/10
          6. P+: Lifting arm, sleeping on Left side, pushing with left hand, driving with left hand (after 15 mins)
          7. P-: Rest


          • SA: 75% with mid-range arc around 90 degrees
          • P+ Test: Push-up produces Mild Pain
          • UCF: 9 deg – No shoulder Sx
          • CF: 43 deg – No shoulder Sx
          • CTF – 48 deg – No shoulder Sx
          • Rot L: 75 deg – No shoulder Sx
          • Rot R: 67 deg – No shoulder Sx


          • I treated him 3 times, feeling adhesion pull “moderately tight” generally in his RC and capsule. No change to SA or Symptoms.
          • While his neck is pretty restricted, it doesn’t seem relevant to the shoulder here. Am I correct?

          Carl Nottoli, DC

            Thank you for the data.

            I would agree that with the information the pain is primarily from the GH and/or AC joint, although the neck is a mess too. Sounds like the inflammation may still be too high and guarding some of the improvements that you are trying to make. Is he resting the shoulder to allow for healing?

            You also said you feel “moderately tight” tension on the adhesion–try to really focus on finding the worst spot. Along with that mind set, also focus on generating the most tension during the patient motion by figuring out which specific motions generate the most tension. For example, if I’m treating subscapularis on a patient with degeneration I have to make sure I’m not forcing any of the arm motion as this can jam the degeneration making it guarded and more inflamed. Try bringing a staff member in the room to do the motion for the patient so you can focus more on feel.

            Lastly, if you are still on coaching bring this case to Dr. Brady.


            Christopher Stepien

              Thanks Carl!

              Will do.

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