Stiff shoulder?

[Immortal25]

Patient was diagnosed as just bilateral shoulder pain but after 5-6 visits to the physio, she still has trouble with abduction in particular for her left sh. I've been giving hot packs before the exercises and it's only slightly improved after so long. The right sh is better so now I'm concentrating a lot on the left. The only real problems are flex and abd of the left sh. Abd is only till 70degrees, after that she would tend to flex the arm at a 30degree instead since it can't be abducted further. Does she have a frozen shoulder? A capsulitis? Bursitis? How to treat this patient effectively? Thanks all!

[physio.smith]

What was the history of onset / progression etc.?
Have you cleared the neck?
Any neural involvement?
Please give more information.
Thanks

[Canuck Physio]

If its capsular, what is the PROM
If its bursitis examine if the biceps causes irritation
What response are the resisted tests, this is quite telling...

Compare all of this and we may have something to look into

Regards

[Immortal25]

Hmm...never checked for neural involvement.

Can't quite remember her history now; need to check it again. But if I'm not mistaken it's quite a sudden onset. And it wasn't caused by some activity. Just sorta got it one day and got progressively worse since. But after coming for physio she has been improving albeit slowly! Perhaps a little too slow.

She can have PFROM but active she's having problem. She'll get some pain as I reach a certain degree or at end range.

Haven't really done much tests, will proceed on those.

[physio.smith]

If no specific injury to shoulders or history of accumulative problem then definitely check neck and neuro.

Make sure that you rule out red flags etc...

Also check history re: any other joint probs...?rheumatological

If not progressing as thought it should discuss with collegues, get second opinion, take a step back and go back to basics and reassess...often the problem will then become clearer.

Good luck

[sarapollo08]

Hi Friend We Should Knew Whats The Reason Behind The Pain In Both Shoulder Then Only We Can Try To Solve The Current Problem Effectively R Else Their Can Also Occur The Recurrence Of The Pain Unless The Root Cause Being Cleared.

Make A Thorough Assessment Of Ur Patient Covering The Whole [picture Of The Patient . Make A Posture Assessment Mainly Apart From The Other Tests U Examine.
Rule Out The Neural Problem First Then Proceed The Soft Tissue Structures Involved .
Sarathi

[physio.irl]

If she has Full passive ROM (i.e.no capsular restriction), but cannot actively move through full range you have to suspect a muscle dysfunction.
How old is this patient? In older age groups, with inability to abduct and particularly if combined with night pain and weakness of abduction and external rotation a rotator cuff tear should be suspected.

This paper will describe some of the tests that you can use to diagnose such tears.
Tennent TD, Beach WR, Meyers JF. A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests.Am J Sports Med. 2003 Jan-Feb;31(1):154-60.

If it is pain alone limiting the movement, and you have ruled out a neural/neck cause, then a local steroid or even local anaesthetic injection will help clarify whether the muscles are pain inhibited or actually torn.

[alophysio]

HI,

I just thought i would put down something that is "out there" - feel your patient's rib cage. Find a rib that seems prominent and maybe even a little tender on the most lateral border. THen hold that rib like you were supporting it medially and superiorly then ask for active ROM again - if it improves (feels easier, lighter, increases ROM etc), your problem is likely to be a thoracic problem, in particular a thoracic motor control problem.

The PROM is normal therefore motor control or myofascial dysfunction is most likely although neural injury is still also possible.

Try it an see - you will be surprised i think!