This topic contains 5 replies, has 1 voice, and was last updated by 
Scott Glidden September 17, 2018 at 8:59 pm.
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Scott Glidden
I’ve got a question on patient management. 41 year old male, R shoulder pain at AC joint for 2 weeks. Flared up playing hockey (7/10). Has been resting (0/10 at rest), 5/10 pinch with use and a hesitant feeling with use as well.
Minimal adhesion and near full ROM with shoulder abduction.
Supraspinatus press= negative
Positive speed’s test–had some minor adhesion (1) at biceps origin in shoulder
I distracted his shoulder and didn’t feel a lot of give, so I believed the AC joint was fairly in-tact (but since I have limited experience with this, I was still unsure).
He did have some mild adhesion (1) in his R biceps tendon, which I treated the next visit. After that it went down to a 2/10 with Speed’s test/use.I had him rest his shoulder for 2 weeks and then come back and see me. When he came back there was no change and since I thought it was possibly an AC joint sprain (grade I or II was my thought at this point), I ordered weighted xrays.
I got an X-ray to check for an AC joint sprain and it came back negative for that, but it did say there was “bone resorption at the right AC joint, likely posttraumatic or result of inflammatory arthropathy.”
What is my best course of action with this patient? Is effectively communicating that 20+ years of rec hockey, football, golf,and basketball have caught up to him and he needs to pick and choose his battles the best option? Should I get an MR to check for soft-tissue anomalies? Is there treatment that I could provide that would be effective? I’d love to hear your thoughts!
Brandon Cohen DC, CSCS
My first question is, “Does he have an inflammatory arthropathy?”
Scott Glidden
To my knowledge he does not have any autoimmune problems. I previously treated him for a “frozen shoulder” in his left shoulder last year. He also has a chronic hip problem that I haven’t checked out. Shoulder isn’t one of the usual spots for problems for RA. I will definitely seek to rule that out/in when I see him next.
Carl Nottoli, DC
The diagnosis is distal clavicle reabsorption. He has full ROM with pain and minimal adhesion. He also points right to the AC joint when it hurts. So he doesn’t need manual therapy.
You could investigate inflammatory arthropathy but based on his Hx he doesn’t have that. To your point, he’s played contact sports and lifted weights for over half of his life. The report that says “post-traumatic” could be trauma but doesn’t have to be.
It’s load and capacity. He has been under extremely high load for the majority of his life. The capacity of the bone is what we are looking at in this case. As we age and our hormone levels change, our bone turnover will slow down. His bone is trying to repair in response to the stress, but cannot keep up–hence the resorption.
This is a serious problem for his shoulder health and load management is the treatment needed.
William Brady, DC
Is the resorption on both sides of the AC joint? Osteolysis of the distal clavicle is a possibility.
Scott Glidden
The resorption is on both sides of the AC joint. I told him that regardless of the blood work he will need to cut back on his activity level a significant amount. I called his PCP regarding the blood work last week since he has a physical coming up and I haven’t heard back from him yet.
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