1/16. Supraclavicular glomus tumor, 20 year history of undiagnosed shoulder pain: a case report.A long-standing case of severe dysesthesia due to a supraclavicular glomus tumor is presented. chronic pain caused by a subcutaneous glomus (non-chemodectoma) tumor is rare and usually misdiagnosed. The supraclavicular location, presentation, and coincidence of trauma history are unique in this case. A 62-year-old male complained of 20 years of intractable right shoulder and supraclavicular region pain, which started 6 months after a fall. The pain was unrelieved by repeated and extensive physical therapy, chiropractic manipulation, local steroid injections, and two shoulder operations. The cause of the condition remained undiagnosed and obscure. Local surgical exploration revealed a subcutaneous grayish mass with pathologically proven glomus tumor. Immediate alleviation of the pain and tenderness followed complete resection of the mass. The patient remained free of pain at a 2-year follow-up. Subcutaneous glomus (non-chemodectoma) tumors can occur in unusual sites, and should be considered in chronic regional pain syndromes. Immediate cure is generally achieved by local resection. Pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report.A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected.- - - - - - - - - - ranking = 4.7988773200543keywords = physical examination, physical (Clic here for more details about this article) |
3/16. 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 = 2.3994386600272keywords = physical examination, physical (Clic here for more details about this article) |
4/16. Acute brachial plexus neuritis: an uncommon cause of shoulder pain.patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy. magnetic resonance imaging of the shoulder and upper arm musculature may reveal denervation within days, allowing prompt diagnosis. electromyography, conducted three to four weeks after the onset of symptoms, can localize the lesion and help confirm the diagnosis. Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in three to four months. patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern. This differentiation is important to avoid unnecessary surgery for cervical spondylotic changes in a patient with a plexitis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. Physical therapy for spinal accessory nerve injury complicated by adhesive capsulitis.BACKGROUND AND PURPOSE: The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. DISCUSSION: This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
6/16. Misinterpretation of regional sensory loss in an injured worker: a case report.Regional patterns of motor or sensory loss are considered indicators of a behavioral component to the complaints of an injured worker. This assumption may lead to a discounting of signs and symptoms with premature return to work and discharge from care. We present the case of a 25-year-old airline baggage handler with an 8-month history of unresolved neck and shoulder complaints who had been returned to work after a lack of objective findings on physical examination. On physiatric evaluation, his unusual pattern of insensitivity to pinprick led to prompt magnetic resonance imaging that revealed a focus of increased intramedullary signal at C6 consistent with a syrinx. This case report shows the importance of a detailed neuromuscular examination coupled with appropriate diagnostic imaging in the assessment of individuals with regional sensory or motor loss so as not to miss more serious spinal cord pathology.- - - - - - - - - - ranking = 2.3994386600272keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Arthroscopic management of painful and stiff scapulothoracic articulation.We present the case of a patient who had chronic refractory scapulothoracic pain accompanied by the loss of scapulothoracic motion. Despite intensive physical therapy, the insidious onset of scapulothoracic pain and stiffness progressed. A wide range of diagnostic tests did not show a systemic, anatomic, or neurologic cause for the disorder. Finally, the patient elected to undergo an arthroscopic release and decompression of the scapulothoracic articulation. The patient had a dramatic response to surgery; the pain was gone immediately, and by 4 months after surgery, her scapulothoracic motion was evaluated as symmetric. One year after the surgery, she maintained an active lifestyle and was extremely satisfied with the result. Progressive and painful loss of shoulder motion in the case reported was due to a rare adhesive inflammation of the scapulothoracic bursa, which was successfully treated using arthroscopic resection. arthroscopy of the scapulothoracic articulation is an option to treat scapulothoracic abnormalities, especially bursitis, but long-term clinical studies are needed to strongly recommend this emerging treatment option.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/16. A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. 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 = 2keywords = physical (Clic here for more details about this article) |
10/16. Quadrilateral space syndrome: a case study and review of the literature.Quadrilateral space syndrome is an uncommon injury. The true prevalence is unknown because of a lack of literature and possible misdiagnosis. prevalence may increase as knowledge of the syndrome increases. The case is presented of a recreational triathlete who had a spontaneous onset of quadrilateral space syndrome. The diagnosis was made by physical examination and confirmed with magnetic resonance imaging. A conservative, yet aggressive rehabilitation programme resulted in functional improvement within six weeks. Results have been maintained for eight weeks.- - - - - - - - - - ranking = 2.3994386600272keywords = physical examination, physical (Clic here for more details about this article) |
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