How I Healed my Frozen Shoulder
Before treating postmastectomy pain, the area of pain should be identified and therapy directed at the innervating nerve. For axillary and arm pain, a second intercostal or T2 nerve root block can be performed ( Figs. 28-13 A and B). For chest wall pain at the mastectomy site, multiple intercostal or thoracic paravertebral nerve blocks (T2-T6) may be helpful. For phantom nipple pain, a fourth intercostal nerve block can be performed (see Table 28-3 ). Tf a prolonged response from these blocks results, repeated blocks are indicated. Tn addition, this block can be done in conjunction with physical therapy for patients with shoulder pain and frozen shoulder. Reflex sympathetic dystrophy (RSD) has been reported to occur after mastectomy. Tf signs of RSD appear, a stellate ganglion block should be considered. Tf a prolonged response results, repeated blocks should be considered. RSD may result in a frozen shoulder as the patient attempts to minimize movement secondary to pain. Therefore,...
To traumatization of various structures and inferior subluxation can lead to injuries, including tendons, capsule or peripheral nerves and plexus. It is important to keep the shoulder correctly positioned to prevent subluxation by orthotic management. Hemi-plegic shoulder pain in stroke may be due to adhesive capsulitis (50 ), shoulder subluxation (44 ), rotator cuff tears (22 ), and shoulder-hand syndrome (16 ) 121 . The etiology of shoulder-hand syndrome with pain of the shoulder or arm and edema of the hand and arm is controversial many authors consider it a form of reflex sympathetic dystrophy complex regional pain syndrome, probably initiated by mechanisms mentioned above. Management includes positioning, orthotic management, physical therapy including steps for reduction of edema, and analgetics. In more severe cases intermediate dosage treatment with oral prednisone is effective 122 .
More proximal surgical procedures usually use more proximal brachial plexus approaches (e.g., interscalene block for shoulder procedures). Clinical applications of interscalene block include all shoulder surgical procedures, including arthroscopic and open procedures,1201 management of frozen shoulder,123 repair of humeral fracture,1221 elbow procedures, carotid endarterectomy, vascular shunts, chronic pain syndromes, pain of the arm and forearm, and cancer pain management. Supraclavicular, 123 infraclavicular,123 and axillary123 blocks are used for elbow, forearm, and hand surgery.
Signal-to-noise ratio about 2 cm or more from the surface coil. When using a plane circular surface coil, the nail plate must be placed against the coil to offer the maximum signal close to the superficial layers of the nail unit. The hand is placed above the head in a supine or prone position with the coil fixed on the centre of the gantry. Full cooperation of the patient and efficient mechanical support with adhesive bandages are necessary. Some patients with painful shoulders (rotator cuff tears, multiple tendon calcifications) or frozen shoulder cannot maintain this position during the entire examination. For study of the toes, the position is more comfortable the patient lies supine with the feet in the gantry. In all cases perfect immobility of the distal phalanx is necessary to avoid movement artefacts, which are particularly disturbing with high spatial resolution. For this reason, children younger than 6 years should not be examined in this manner. Routine examination...
Edema over the site of injury and distally may be present. At first, the involved extremity is usually warm, red, and dry but occasionally may be cold. Over time, the extremity usually becomes cool, pale, cyanotic, and hyperhydrotic. Early on, the nails may become thickened and the hair darker. Later, the hair may be lost in the affected areas, the skin may become shiny, and the nails may break. Dystrophy and atrophy of subcutaneous tissue, muscles, and bone may be present. Nodular fasciitis of the palmar or plantar skin may be present. RSD affecting the hand may be associated with a frozen shoulder. y Motor manifestations variably present include weakness, an enhanced physiological tremor, spasm and increased reflexes, focal dystonia, and an inability to initiate movement. Exercise or use may aggravate RSD complaints.
True stiffness, defined as a mechanical block to passive motion, can present with or without pain and can be global or in selected motions. In most athletes, stiffness occurs in the presence of a painful shoulder. When stiffness does coincide with pain, the reader is directed to the pain as chief complaint section, as diagnosis and treatment of the pain source will often lead to resolution of the stiffness. Occasionally, stiffness can contribute to pain, especially in the throwing athlete. One example of this is the development of posterior capsular tightness in pitchers. This is likely an adaptive change from the powerful forces created in repetitive pitching. This stiffness can be measured as the distance between the coracoid and the antecubital fossa when the athlete is in a position of maximal horizontal adduction with a straight elbow (Fig. 16-30). Other causes of stiffness in the shoulder include adhesive capsulitis, osteoarthritis, or synovitis. In addition, patients who have...
When the spinal accessory nerve is injured and the sternomastoid and trapezius muscles subsequently paralyzed, shoulder pain and restricted range of motion may occur. In these situations, aggressive postoperative physical therapy can prevent the development of adhesive capsulitis and scapular winging, although normal shoulder range of motion and strength are not possible.54 Isolated glossopharyngeal or hypoglossal nerve paralysis is not usually associated with significant morbidity, although speech and swallowing therapy may assist with any resultant dysphagia or articulatory difficulties. However, combinations of nerve paralyses such as a simultaneous
As with GCA, polymyalgia rheumatica usually occurs in whites older than 50 years, especially those of northern European ancestry. Constitutional symptoms such as fever, fatigue, malaise, and weight loss occur early on, followed by neck and proximal upper extremity muscle aches. PMR is sometimes misdiagnosed as a frozen shoulder because of this. PMR later involves the lower extremity proximal muscles of the hips and thighs. Morning stiffness of large joints can make it difficult for the patient to perform ADLs, such as getting out of bed or combing the hair. The only typical physical finding is muscle tenderness, but without other objective signs. A transient mild synovitis of the knees, wrists, and sternoclavicular joints might occur. Diagnosis is made clinically by noting the combination of proximal extremity and truncal muscle pain and stiffness, increased ESR, and response to steroids.
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