1/5. Thoracic disc herniation: a diagnostic challenge.An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia, prompted further investigation and this revealed a low thoracic herniation. The nucleotomy which followed afterwards lead to a rapid improvement of both the shoulder symptoms and the incomplete paraplegia. This case report shows that chronic shoulder pain may be caused or exacerbated by a thoracic disc herniation in the low thoracic spine. Therefore, prior to performing surgery for peripheral joint symptomatology, the possibility of a central sensitising trigger should be excluded by physical examination of neural tissue dynamics as well as any other necessary confirmatory investigations.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/5. Diagnosing suprascapular neuropathy in patients with shoulder dysfunction: a report of 5 cases.BACKGROUND AND PURPOSE: Suprascapular neuropathy, resulting in shoulder pain and weakness, is frequently misdiagnosed. The consequences of misdiagnosis can include inappropriate physical rehabilitation or surgical procedures. The purpose of this case report is to describe the differential diagnosis of suprascapular neuropathy. CASE DESCRIPTIONS: Five patients were initially diagnosed with subacromial impingement syndrome and referred for physical therapy. Physical therapist examination findings were consistent with subacromial impingement syndrome and suprascapular neuropathy. Subsequent electrophysiologic testing confirmed the diagnosis of suprascapular neuropathy in all 5 patients. DISCUSSION: The differential diagnosis of patients with suprascapular neuropathy includes subacromial impingement syndrome, rotator cuff pathology, C5-6 radiculopathy, and upper trunk brachial plexopathy. The diagnostic process and a table with key findings based on evidence and clinical experience is presented for differential diagnosis.- - - - - - - - - - ranking = 0.60701688881674keywords = physical (Clic here for more details about this article) |
3/5. rotator cuff impingement.OBJECTIVE: To present a case of shoulder impingement syndrome managed with a conservative multimodal treatment approach. CLINICAL FEATURES: A patient had anterior shoulder pain and a diffuse ache in the right upper arm, with tenderness in the shoulder region on palpation. Shoulder range of motion was limited with pain and catching, coupled with limited and painful cervical motion. After physical and orthopedic examination, a clinical diagnosis of shoulder impingement syndrome was made. INTERVENTIONS AND OUTCOME: The patient underwent a multimodal treatment protocol including soft tissue therapy, phonophoresis, diversified manipulation; and rotator cuff and shoulder girdle muscle exercises. Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities. CONCLUSION: This case report shows the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with shoulder impingement syndrome.- - - - - - - - - - ranking = 0.30350844440837keywords = physical (Clic here for more details about this article) |
4/5. The os acromiale: another cause of impingement.Impingement of the shoulder is a relatively common clinical entity. The os acromiale anomaly is an uncommon one (1-8%) but can be an important cause of the impingement syndrome. The most common place of nonfusion is between the meso- and meta-acromion. The key to diagnosis is a history and physical examination compatible with the impingement syndrome and appropriate radiologic studies (i.e., an axillary view or profile view or computed tomographic scan if necessary). After diagnosis, the initial treatment is conservative with rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), injections of corticosteroids in the subacromial space, and most importantly, an appropriate rehabilitation program. If unsuccessful, treatment should be planned based on the size of the unfused fragments. Small fragments (< 4 cm) may be removed by either arthroscopic or open means. Larger fragments may require an attempt at bone grafting and fixation since their removal may result in loss of strength of the deltoid.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/5. Management of shoulder dysfunction with an alternative model of orthopaedic physical therapy intervention: a case report.One common approach to patient care in dealing with many musculoskeletal dysfunctions involves two to three patient visits to physical therapy per week over a period of weeks. Some patients may benefit from an alternative, graduated treatment model emphasizing a minimal number of office visits and focusing on intensive patient education, home program therapeutic exercise, and specific manual interventions. Patient education focuses on home program compliance and empowerment of the patient by adjusting office visits as needed based on patient progress rather than multiple patient contacts in the first weeks. This emphasis may improve long-term patient compliance by preventing the development of an external locus of control in which the patient is dependent upon the therapist for management of his/her condition. This case study is an example of the use of this alternative treatment model for the resolution of impingement syndrome and adhesive capsulitis in a 53-year-old female. A comprehensive program of patient education and home exercise was initiated during the first visit. Joint mobilization and active exercise were performed at each subsequent visit. The patient was seen a total of six visits over a period of approximately 10 1/2 weeks, followed up via telephone at 1 month after the last treatment and reexamined after 1 year. The objective exam revealed no abnormalities after the last visit or after 1 year. The patient subjectively reported compliance with the home program for 6 months after the last visit. This model of patient care was successful for the patient described in this case study. The treatment approach may have contributed to the development of an internal locus of control by allowing the patient to be as actively involved as possible in the treatment of her condition. In addition, this approach is timely when one considers current reimbursement systems. Though successful with this patient, this graduated treatment model is not intended to be applicable to every patient with this diagnosis.- - - - - - - - - - ranking = 1.5175422220418keywords = physical (Clic here for more details about this article) |