This topic contains 2 replies, has 2 voices, and was last updated by 
Christopher Stepien November 25, 2018 at 2:59 pm.
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Posts
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Christopher Stepien
47 year old male
- B shoulder pain (points with whole hand)
- Ache/sharp
- 5-8/10
- P+: Putting on shirt,
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- reaching forward [shoulder]
- keeping either hand on steering wheel causes respective shoulder pain [shoulder]
- military press [shoulder]
- raise either arm forward or out to side to 90 degrees [shoulder]
- standing for 30 minutes [neck?]
- P-:
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- ice,
- heat,
- sitting with elbow supported,
- cortisone [shoulder]
Initial Dx Hypothesis:
- Shoulder
- Some neck involvement
2nd order:
- Over 10 years
- Remembers landing on shoulder several times during HS football and not being able to move it
- X-rays confirm major spurs (I’m guessing at acromion) and neck arthritis
- Cortisone with PT helped relieved one shoulder from 8/10 to 5/10
- Had 4 car accidents (3 major ones before age 20)
Dx:
- Acromion spurs
- Adhesion
Question:
- Can distraction of the GH joint cause a spur to increase shoulder pain?
- This sounds like a neck problem to me.
Carl Nottoli, DC
Is this case post consultation before exam?
You’re definitely looking at some serious shoulder problems here. I agree with your ddx of impingement due to degeneration. This will cause wear of the supraspinatus tendons to fray and tear. All of his provocative movements point to this as the major culprit.
Nice job making a note of the outlier being the neck symptoms. Did you ask him where he feels the neck pain, intensity, and quality? It’s not uncommon for really bad shoulders to cause/exacerbate neck problems.
To your question about GH distraction—it should open the subacromial space more. I would be willing to bet he’s got adhesion in his cervical/scapular muscles and maybe the constant tone to keep the shoulders supported and moving to avoid pain is what is causing neck symptoms.
At this point your exam should consist of Level material for shoulder and cervical spine, resistance testing to the rotator cuff muscles, Hawkins and neers tests. The last two are ortho tests for impingement and you can add varying degrees of adduction as well. I would also be curious of doing NR tension tests as the neck is under strain in static postures.
I hope this helps. Keep us updated.
Christopher Stepien
Is this case post consultation before exam? Yes.
At this point your exam should consist of:
Level material for shoulder and cervical spine,
resistance testing to the rotator cuff muscles,
Hawkins and neers tests. The last two are ortho tests for impingement and you can add varying degrees of adduction as well.
I would also be curious of doing NR tension tests as the neck is under strain in static postures.I hope this helps. Keep us updated.
HUGE – Will report back in. TY!
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