Saturday, July 24, 2010

Shoulder Assessment with a surprise

This week even I got a surprise. I got a call from a chiropractor in town who was seeing a mutual patient. He called me to give me the results of an MRI that I had suggested to the client that if I were her I would get. The results were a full thickness tear of subscapularis, a partial tear of supraspinatus, arthritis in the AC joint, and arthritis in the labrium. He called to tell me how he couldn't believe he had missed the tears and I was right in my assessment of this patient. That was not the only surprise in this case. When I did the assessment she had full flexion, extension, abduction, internal and external rotation actively. She did not test weak in any of the muscles surrounding the joint. What? That's right, the only thing that allerted me was when we were attempting some simple strengthening exercises of flexion, she had a moment where the arm grabbed on the way down which is sometimes an indication that supraspinatus is partially toren and will grab the humerus on the eccentric load. The next indication was when I had her on the massage table I felt the grinding of the joint when moving the arm from external to internal rom. I noticed also that her SC joint was misaligned on that same side and was painful on palpation and was not smooth at either end of the clavical. There seemed to be that familiar almost clunk that a toren labrium will produce when moving once again from internal to external rom. So at the end of her third session we talked about her upcoming hip replacement and that after that she would not be able to get a MRI of her shoulder so why not go ahead and find out for sure what was going on with the shoulder. She originally came to me for some strength exercises of her hip and what she thought was a weakening shoulder over the course of the last year. What a surprise for her to find out not only will she be facing a hip replacement, but now a shoulder repair as well. This shows you the necessity and importance of feeling, listening, and assessing.

Happy Assessing, Debbie