Shoulder

Shoulder Injury And Chiropractic Rehabilitation – Ski Crash

March 7, 2011 by drburt 2 Comments

Shoulder Injury And Chiropractic Rehabilitation – Ski Crash

This is the most recent Shoulder Injury case after skiing accident that I have finished rehabilitating in my San Leandro Chiropractic Clinic. Patient is a twenty five year old female. She is a full time student and loves to be involved in different sport activities. She was in a great deal of pain for two months prior coming to my office for rehabilitation of her shoulder.

About two months ago my patient was enjoying the white powdered slopes of Lake Tahoe. Unexpectedly she lost a control on one of the turns and fell really hard on her left shoulder. The left shoulder was in a dislocated position for about one hour. That how long it took for paramedics to reach her on a slope. She was taken to a near by Hospital E.R. and was diagnosed with minor shoulder dislocation without any fracture. She got very lucky that her bones were not broken. As usual patient was discharged and prescribed a ton of pain killers with advice to get some rest and applying ice on the injured area.

After getting back to Bay Area, this patient made an appointment with a local orthopedic doctor. This doctor was “nice enough” to see her in about two months. What if patient needs to be seen ASAP, why such a long delay? After all, evaluation and examination does not take hours, and any doctor can figure out what is going within given time frame.

During these two months period my patient had been taken pain medications which would become less and less effective because the intensity of the pain would go up every week. The pain level began affecting her sleep patterns and thus her ability to concentrate on her professional studies. Sleeping on a left side was out of question at all. She stopped working out completely and had to eliminate some of her activities of daily living.

Many would wonder why so much pain, if hospital has discharged her, and orthopedist thought she could wait for two months and he could cure her shoulder in one visit. The answer is simple enough. This patient had soft tissue injury which required immediate rehabilitation post skiing accident. The best result with soft tissue injury rehabilitation, are within first 72 hour post trauma. Read this post for more scientific explanation: “4 Stages of Soft Tissue Healing.” This particular patient had to wait eight weeks and be in a miserable pain.

EXAMINATION:

During examination I have discovered that patient has lost about 70-80% of range of motion in her left shoulder with severe pain at the end range. This pain was present on active and passive range of motion (ROM) tests. Pain during active and passive ROM is a sign that her muscles, ligaments and tendons were injured – sprain and strain injury. All of the rotator cuff muscles were strained with severe pain during palpation.

I knew that I could help this patient. However, eight weeks of lack of motion in a left shoulder caused increased fibrotic tissue around injured soft tissues. That meant only one thing – longer rehabilitation process. This patient was very eager to fix her problem so the compliance was not an issue.

TREATMENT:

Each session consisted of full spine chiropractic adjustments, which helped to enhance the ability of her body to heal itself. If you want to know how this works please refer to this post: “Relationship of the nervous system and spine to organs.” Prior chiropractic adjustment she would get 15 minutes of electric stimulation with moist hot pack on her left shoulder followed by 20 minutes deep tissue massage from my CMT. After that I would performed post isometric relaxation of her shoulder in flexion, extension, internal and external rotation, adduction and abduction.

RESULTS:

A noticeable response to a therapy was after session number three. Pain level has gone down and ROM has gone up. My original plan was two week of rehabilitation with frequency at three times a week – total six sessions. However, it took me additional 3 sessions to bring this injured shoulder to a full ROM and almost no pain level.

At the end of the session number nine patient informed me that she can have a good night sleep, she can lay down on her left shoulder and she is back to her activities of daily living. She began her exercise routine after last session. Patient was discharged with instructions on how to strengthen and stretch the injured body part.

Below is a Video Testimonial From a Happy Camper!

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Thoracic Outlet Syndrome, Physiology and Causes – Part 1/3

October 22, 2010 by drburt 2 Comments

What is Thoracic Outlet Syndrome?

In order to know what Thoracic Outlet Syndrome is, or TOS, it’s best to know what and where you can find the Thoracic Outlet. The space between the collarbone and the first rib is known as the Thoracic Outlet.

The TOS involves a group of disorders that involves the thoracic outlet whether as caused by an injury, compression or irritation of the blood vessels, nerves and veins. The patient may experience neck pain and/or shoulder pain that reaches the arms and even causes finger numbness.

What Are the Causes of TOS?

The causes for Thoracic Outlet Syndrome vary greatly but generally, it is caused by compression of the blood vessels and nerves in the thoracic outlet. This compression can be caused by any of the following: trauma, congenital defects, poor posture, activity, joint pressure or even pregnancy.

You can have a congenital defect that may cause you to suffer from this condition. If you have an extra rib just above your first rib (cervical rib), or if you have an abnormal fibrous band that connects the spine to your rib, then you are more likely to have TOS.

If you suffer from an accident that causes compression to your thoracic outlet and you experience pain in that area, then you may be suffering from TOS. The onset of the symptoms doesn’t occur after the trauma though as it is usually delayed.

Poor posture can compress the thoracic outlet. Drooped shoulders as well as constantly keeping a forward head position could cause TOS. Repetitive activity is also another cause as the body’s tissue can wear out over time as you do the same activity over and over again. The types of repetitive activities vary from typing to swimming.

Being overweight causes different types of problems. When you are overweight or obese, you tend to put more pressure on your joints that can also cause Thoracic Outlet Syndrome. It’s like carrying around a huge backpack wherever you go.

Pregnancy, just like with obesity, can also cause thoracic outlet syndrome. But with pregnancy, the woman’s body changes and one of these changes happen in the joints. The joints tend to loosen up during pregnancy and women become more prone to suffering from TOS.

What are the Symptoms to Watch out for?

The symptoms of the Thoracic Outlet Syndrome vary as it depends on which of the structures are suffering from compression. The nerves, veins or arteries can get compressed and symptoms such as shoulder or neck pain, pain on the hands and arms, numbness of fingers, vein thrombosis, swelling and arm pain, collarbone throbbing, and discoloration of the hand are just some of the symptoms associated with Thoracic Outlet Syndrome.

How is it detected?

The Thoracic Outlet Syndrome is difficult to diagnose as the severity and symptoms vary greatly. Doctors would suggest the patient to take medical tests to see if they are indeed suffering from TOS. Such tests include Adson’s maneuver, Wright test and Roos stress test.

If you have any additional information about TOS please feel free to ad it in a comment section.

Chiropractic Rehabilitation and 4 Stages of Soft Tissue Healing

August 20, 2010 by drburt 13 Comments

The healing process is divided into four broad stages which are not mutually exclusive and overlap considerably.

1. Initial vascular reaction – Active Swelling

2. Inflammatory response – Passive Congestion

3. Proliferative phase – Repair

4. Remodeling

Wound healing refers to the body’s replacement of destroyed tissue by living tissue (Walter & Israel 1987). It comprises of two essential components whose differentiation is based on resultant tissue: Regeneration and Repair.

TISSUE INJURY CAUSES RESTRICTION OF MOTION DUE TO:

Inflammation & Swelling
Pain
Muscle Spasm

THE MAJOR GOALS OF CHIROPRACTIC CARE:

Relieve Pain
Promote Full Healing
Restore & Maintain Full Function
Reduce the Likelihood of Re-Injury
Prevent Accelerated Degeneration

Chiropractic Care Should Continue Throughout the Repair Stage. It Take Longer For Tissues to Heal & Normal Function to be Restored Than it Takes for Pain Relief. Pain Relief is not the Only Goal. Chiropractic Helps:

Restore Normal Motion, Function & Biomechanics
Improve Alignment of New Connective Tissue
Prevent Shortening of Scar Tissue & Chronic Stiffness
Restore & Maintain Flexibility of Ligaments & Muscles
Restore Normal Muscle Tone
Promote Quicker, More Effective Healing
Restore & Maintain Normal Sensation
Reduce the Risk of Re-Injury and Degeneration

STAGES OF SOFT TISSUE HEALING

STAGE I: ACTIVE SWELLING

Swelling Occurs for 12 to 72 hours
Motion is lost and pain increases

Goals of Care: Minimize pain and swelling

Care:

Rest & Support of Injured Area
Ice to Block Swelling, Pain, and Spasm

STAGE II: PASSIVE CONGESTION

Fluid trapped in tissues restricts motion, causes pain, & delays healing. Begins by second to fourth day

Goals of Care for Passive Congestion:

Remove fluid
Pain Relief
Begin to restore range of motion

Care:

Chiropractic Adjustments Help

restore motion
block pain
restore normal sensation
relax tight muscles
remove swelling
accelerate healing

Heat and Cold to Remove Fluid
Controlled Motion Exercises
Physical Therapy helps in Some Cases
Acupuncture Can Help With Pain Control

STAGE III: REPAIR

Beginning 5 days after injury, scar tissue is made for up to 6 weeks.

Lack of motion causes excess scar tissue in dense patterns disrupting normal function causing:

Excess Scarring
Chronic Stiffness
Limited Range of Motion
Poor Biomechanics
Chronic Pain
Weak Muscles & Ligaments
Loss of Normal Sensation
Poor Nutrition
Increased risk of Re-Injury
Accelerated Degeneration

If Motion is Restored & Maintained, Tissues Heal in a Much More Functional Way.

Coals of Repair Stage:

Restore Normal Range of Motion
Restore Sensation
Promote Full Healing
Relieve Pain

STAGE IV: REMODELING

Connective tissue remodels for better strength & flexibility. This often takes 3 to 14 week but may take up to 1 year with severe injury.

Chiropractic Helps Achieve these Goals:

Improve & Maintain Motion & Flexibility
Restore & Maintain Function
Reduce Chronic Pain
Reduce Risk of Re-Injury & Degeneration

This Post was based on Dr. Malik Slosberg’s Research.

Frozen Shoulder Syndrome and Chiropractic Rehabilitation

June 7, 2010 by drburt 6 Comments

Frozen Shoulder Syndrome and Chiropractic Rehabilitation

Frozen shoulder (FS),medically referred to as adhesive capsulitis, is a disorder in which the the connective tissue surrounding the glenohumeral joint, becomes inflamed and stiff, and grows together with abnormal bands of tissue, called adhesions, greatly restricting motion and causing chronic pain. Some people experiencing this kind of problem don’t go for any forms of treatment in order to gain back the motion of their joints. The condition will get better eventually without treatment but it will take a very long time to do so. The pain and the reduced Range of Motion without any form of treatment means only one thing, you won’t be able to function to a full capacity. The more you try to move your joint, the more pain you will experience. Therefore, it is best to seek treatment for pain control. There several options for patients who have frozen shoulder pain:

1. Oral and Injectible Steroids

2.Hydrodilation and Hydroplasty

3. Chriopractic rehabilitation with Physical Therapy

4. Manipulation Under Anesthesia

Frozen shoulder(FS) is more common for people between the ages of 40 and 60. If you have diabetes, you are more prone to experiencing frozen shoulders as around 20% of diabetic patients also suffer from this condition at one point. Though, the actual causes of FS are still inconclusive but there are risk factors that may increase your chances of suffering from this condition. The conditon is twice more common in women than men. If you are between the ages of 40 and 60 and female who has diabetes, you have a higher risk of acquiring a frozen shoulder. Endocrine problems also increase your chance of experiencing a frozen shoulder. If you have Parkinson’s disease, you are also at a higher risk of suffering from a FS. Lastly, if you suffered from a shoulder injury or trauma and you immobilized your shoulder joints for a long period of time, you have the highest risk of developing a frozen shoulder.

According to health professionals who treat FS, the condition generally follows a course of three stages:

Stage one: a slow onset of pain, and the shoulder gradually loses the range of motion. This stage can last from six weeks to nine months.
Stage two: a slow improvement in pain relief, with stiffness remaining. This stage can last from four to nine months.
Stage three: a “thawing” as shoulder slowly regains motion and pain is relieved. This stage can last from five to 26 months.

There are two options for a treatment of FS: nonsurgical and surgical treatment. As a rule of thumb, the health care professional would advise the least invasive treatment first before they ask for a surgical intervention. For nonsurgical treatment there are chiropractic care and physical therapy, manipulation under anesthesia, as well as pain control using steroid medication.

Chiropractic care is a successful method in easing the frozen shoulder pain. Doctors of Chiropractic use TENS units, Ultraound, Erchonia Cold Laser PL 5000, stretching, educating patients about lifestyle change and diet. The length of time spent on the chiropractic treatment depends on the severity of the condition. If the pain is more advance it can take months to rehabilitate the shoulder. Chiropractic can limit the devastating effects of all forms of physical disability such as FS. At this point research into its cause remains inconclusive.

As a general rule, prevention is better than cure. With chiropractic care, you can prevent FS even before it sets in. When you start feeling a slight pain in your shoulder area, you can try chiropractic care to avoid the stiffening of the joint that causes extreme pain and immobilization. If prevention is unsuccessful, treating the frozen shoulder with chiropractic care requires the use of modalities, chiropractic adjustmnts and deep tissue massage. This treatment is used to manage the pain, inflammation and increase range of Motion.

In the majority of cases, chiropractic involves few risks and has been proven beneficial in treating a FS syndrome. Reputable chiropractic professionals will assure their patients of the best program to follow in maintaining optimum physical movement and a quality life.