Feasibility of PRM in the treatment of painful shoulder syndrome

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Rodney Jones
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1 Feasibility of PRM in the treatment of painful shoulder syndrome MUDr. Ludmila Sobotková Rehabilitation clinic Plzeň Czech Republic INTERNATIONAL PRM CONGRESS PRAGUE, CZ 1

2 Painful shoulder syndrome Aetiology: traumatic or non-traumatic Non-traumatic causes: Impairment of rotator cuff 65 % Capsulitis 11 % Impairment of acromioclavicular joint 10 % Functional disorders of cervical / thoracic spine 5 % Other causes 9 % INTERNATIONAL PRM CONGRESS PRAGUE, CZ 2

3 CASES Painful shoulder syndrome due long-term overload Woman, 59 years, long-term symptoms under load, with limited elevation, outer rotation in the right shoulder, lately night pains. Personal history - post fractura later.clav. right /2009/ RTG of the right shoulder: arthritic changes of I. gr.; USG: bursitis subakromialis, calcifications in VT humerus and in subdeltoidal direction. RTG C-spine - straightened, discopathies C5-C7 with spondylosis, UV arthritis. INTERNATIONAL PRM CONGRESS PRAGUE, CZ 3

4 Orthopaedic examination: acute bursitis subakromialis Treatment: NSAID (adverse effects in GIT) PRM MD Shoulder + MD Matrix 2x weekly Guna Flam 3 x 15 gtt Treatment effects - successive alleviation of night pains, improved mobility; subsequently rehabilitation could be arranged. INTERNATIONAL PRM CONGRESS PRAGUE, CZ 4

5 Man, 61 years - protracted pains in right shoulder (3 years), symptoms started during the work with a bush-cutter, repeated Diprophos injections at orthopaedic clinic, rehabilitation RTG of the right shoulder without pathological findings, in 2012 MRI revealed partial rupture in the attachment of m. supraspinatus tendon, MRI C-spine - discopathy C5/6 with relative stenosis of spinal canal Personal history IHD, post MI, stent implantation, hypothyreosis, lipid metabolism disorder INTERNATIONAL PRM CONGRESS PRAGUE, CZ 5

6 CASES Clinical examination - decentered scapula with stiff myofascial changes, multiply TrP through m. supraand infraspinatus right, protraction of the right shoulder, slightly limited elevation and outer rotation, positive resistance tests for m. supraspinatus, in the right shoulder distinctive snapping phenomenon Treatment MD Shoulder 1 amp 1x weekly, injected around VT humerus + trigger points. Treatment effect - total alleviation of symptoms INTERNATIONAL PRM CONGRESS PRAGUE, CZ 6

Clinical findings: C-spine steady, weakened neck muscles, bloc position of upper T-spine, crepitations in the right shoulder, both rotations limited and painful, normal elevation, abduction not

7 Clinical findings: C-spine steady, weakened neck muscles, bloc position of upper T-spine, crepitations in the right shoulder, both rotations limited and painful, normal elevation, abduction not painful, resistance tests positive for m. biceps brachii, infraspinatus, subscapularis Treatment - ultrasound on frontal shoulder area and long head of m. biceps daily (total 6x), consequently MD Shoulder + MD Matrix 1 amp. 2x weekly for 2 weeks, followed by 1x weekly (total 10 applications), Guna Basic 1x daily (in the evening) INTERNATIONAL PRM CONGRESS PRAGUE, CZ 9

8 Treatment effect - following 4 applications improvement, upon treatment completion the right shoulder without pains upon load Woman, 79 years, progressing pains of the right shoulder when in motions, worsened mobility Personal history: asthma bronchiale, polynodal struma TG, HCH, HLP, skeletal osteopenia, polyarthritic syndrome INTERNATIONAL PRM CONGRESS PRAGUE, CZ 10

9 Clinical examination: RTG showed arthritic changes II. gr. of the right shoulder; USG: arthritic edges of humerus head, subacromial area effused. Chronic effusion of C/Th passing, shoulder in protraction, effused as a whole, motions painful, mainly inner rotation, elevation, abduction Treatment - rehabilitation (physical/exercise), consequently MD Shoulder 1x weekly (total 10 applications) + Guna Arthro 10 gtt 3x daily INTERNATIONAL PRM CONGRESS PRAGUE, CZ 11

10 Gradual treatment effect, upon injections application long-term Guna Arthro treatment. Conclusion Without adverse effects Safe treatment Advantage in polymorbid patients Compatible with physiotherapeutic procedures Significant benefits in post-traumatic conditions INTERNATIONAL PRM CONGRESS PRAGUE, CZ 12

Rehabilitation Guidelines for Large Rotator Cuff Repair

Rehabilitation Guidelines for Large Rotator Cuff Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the