Shoulder and arm pain

Hi all

I have a patient with pain and numbness down the lateral side of the right arm and hand (palmart and dorsalt + fingers). He can´t remember how it started, maybe woke up with it. He especially feels the symptoms when he´s using the pc-mouse.

Ojectives:
- Lower right shoulder
- Normal strength in flex+ext in shoulder, elbow and wrist
- Normal movement in Fflex, abd and ext.
- Stiffness in med. and lat rotation
- The median nerve is not painfull
- Very active triggerpoints in mm. scalenii, upper m. trapezius, m. infraspinatus and m. pectoralis minor. (all produces strong pain down in the fingers)
- Palpationsoreness in long biceps tendon

Tretment:
(I have been treating him for 3 weeks)
- Streching and deep massage of the "active muscles"
- Pressing down 1. rib
- Advises about how to use the pc-mouse

It has been helping a little bit, but some days are still very painfull for him.

Have you got an idea for another aproach? All sugestions are very welcome

Thanks
Amaj

[Physiobase]

Check the neck fully, correct and protraction of the head on the shoulders. Release the supraspinatus in the fossa etc.

Check for all neuro first though and clear for mm involvement/weakness, reflexes that could indicate nerver root involvement. Perhaps tape to inhibit the upper trapezius as a test to localise the problem area. If he is not using a cordless, wireless mouse then suggest investing. This does give more freedom to the hand and arm.

Keep in mind it is no uncommon to give youself a rotator cuff tear or nerve traction injury in the axila while sleeping. Ask about how he sleeps, pillows etc and correct as needed to unweight the head on the shoulders while symptoms are persisting.

Look forward to more comments on your assessment 8o

Thanks for your reply!

It was some very useful ideas, and I have tried them one him yesterday But I do not know what you mean by releasing supraspinatus?

Thanks again
- Amaj

[Physiobase]

Support the weight of the arm, perhaps with him sitting and with the arm supported on a table,pillows etc. The do some deep tissue work along the supraspinous fossa. Supporting the arm allows the upper traps. to relax thus giving you more access to the deeper supraspinatus muscle. On could then try taping down the traps when they are in the relaxed position to "inhibit" their action somewhat. I have found this very useful in acute shoulder joint issues with referred arm symptoms.

[alophysio]

Hi.

Only because no one has pointed it out - if you have altered sensation past the deltoid tuberosity, aren't you meant to do a neuro screen and test the C/S as well?

So my suggestion is to test the C/S and the T/S. They do not have to reproduce the pain, just make sure they all feel nice and mobile and symmetrical with equal F and E and ROt and LF ROM...

Have fun

Thanks for your interest

It seems the thinner pillow has been helping quite a lot. He has just been scanned and it shows:
- C3-C4: Osteofyts causing protrusion in right neural foramina
- C5-C6: A little les space around medulla spinalis
- C6-C7: Les space in right neural foramina

Oh my... I am stil a novice :eek I can reproduce his symptoms in cervical ekstension and right lat. flexion and in right lat. rotation. I have been mobelising/strechting him in the other direction, and it feels good, but it does not change his symptoms.

I am still strecthing all the neck muscles and doing some deep massage in the active muscles (also supraspinatus it works well) But how much can i mobilise the Cervical joints? He is sore on the joints, but none of them seems "locked", but I don´t have much experience in this area.

Amaj

[arkesh_physio]

hi,
u have 2 feel the amount of transilation in Cx,which according 2 me must be restricted,so u have 2 continue mobln of Cx till the symptoms centralise.
regards
ark.

I´m sorry. I think I wrote it wrongly. His symptoms are gone in the opposite direction of the peripheralising movements, but when he is back in neutral, his symptoms are "no better"...

-Amaj

He came in today with no symptoms since the last treatment, only a little numbness in the fingertips when shaving and using the mouse. So that is great

Thanks for your help
- Amaj

[linbin]

hi amaj
in such cases we should also think about mechanosensitivity of the nerve roots. his symptom presentation is that of mechanocensitivity of c5nerve root.the nerve was sensitive to compression more,thats why movement of extension,same side flexion and rotation causing pain.treatment technique described by elvey and hall is effective insuch cases.