Isolated shoulder internal rotation restriction

-



Isolated shoulder internal rotation restrictions are rare clinical entities for physiotherapist to encounter in OPD set ups.
According to cyriax J in a pan-capsular involvement there is more external rotation restriction than abduction restriction than internal rotation. This restriction pattern is called capsular pattern. So only limitation of internal rotation is attributed to involvement of structures other than capsule i.e. muscles & IDK (labrum problems) etc.

A case in my clinic: A 42 year male reported with lateral arm pain. The patient has cervical spine involvement with Rt side rotation, side bend & back ward bending limited terminally but no ULTT tests ware positive. Both side levator scapulae ware tight.
First 10 sitting ware spend to improve ROM & myofascial work to improve length of elevators of scapula without much avail.

During the second 10 sitting it was found that shoulder IR/hand behind back is limited could reach maximum up to L3. No other shoulder tests are positive. No rotator cuff palpation is positive. During the resisted or active IR the pain was referred o the same spot of the lateral arm. This was little unusual for me. Resisted IR test refers to IDK of shoulder.

I found an opportunity to explore the possibility what is in the literature. So I searched PUBMED with key words (shoulder + Isolated + internal rotation + stiffness). I found 3relevant papers on this issue. Following is the summary

1. Laban et al have described “Occult periarthrosis of the shoulder”. According to this author shoulder internal rotation restriction may lead to complaints of lateral elbow pain similar to complaints of lateral epicondylitis. People from both sexes & age group from 33 to 87 yrs ware found to be affected in this study. The authors have suggested that occult shoulder periarthrosis is interlinked in a pathokinetic chain potentially predisposing to the presenting symptoms of tennis elbow.

2. Lin et al have found a significant relationship between internal rotation and posterior shoulder tightness.

3. Hung et al investigate differences in muscle stiffness between subjects with stiff shoulders and controls, and to determine the correlation between posterior shoulder muscle stiffness and ROM. This study found significant correlations were found between internal rotation and stiffness of 3 muscles i.e. posterior deltoid, infraspinatus, and teres minor. Among these 3 muscles, posterior deltoid muscle stiffness accounted for 51% of the variance in shoulder internal rotation beyond stiffness from the infraspinatus and teres minor muscles.

This study concluded that muscle stiffness is related to shoulder range of motion. It is important to consider the posterior deltoid, infraspinatus, and teres minor muscles in the rehabilitation of patients with restricted internal rotation of the shoulder.

References:
1. Laban MM; Am J Phys Med Rehabil. 2005 Nov;84(11):895-8. (Occult periarthrosis of the shoulder: a possible progenitor of tennis elbow.)
2. Lin JJ et al; Man Ther. 2006 May;11(2):146-52. Epub 2005 Aug 10. (Reliability and validity of shoulder tightness measurement in patients with stiff shoulders.)
3. Hung CJ et al; J Rehabil Med. 2010 Mar;42(3):216-20. (Relationships between posterior shoulder muscle stiffness and rotation in patients with stiff shoulder.)





Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an...
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro...
Read more

Chronic fatigue syndrome

-
Introduction: Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as: (1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue. The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activat...
Read more