Chapter 5: Treatment of a Mechanical Joint Dysfunction
Bob's Shoulder
Bob, a 45-year-old graphic designer, is a weekend warrior an avid tennis player and gardener. He'd often spend his Saturdays serving aces and his Sundays tilling the soil. For the past two months, a nagging ache had been developing in his left shoulder, but he chalked it up to being out of shape. The pain was dull at first, a persistent throb after a long day of yard work. He could still lift objects, though reaching for something on a high shelf now felt like a chore.
Over time, the pain intensified. It began to interrupt his sleep, forcing him to toss and turn throughout the night. The simple act of putting on a jacket or reaching into the back seat of his car became a sharp, burning sensation. His tennis serve, once powerful and effortless, now felt weak and painful. Frustration mounted as he had to sit out games and abandon his beloved garden projects.
Bob does not complain of tingling or numbness, his reflexes are symmetrical and 1/2 right and left. He has no tenderness over his bicep tendon and his bicep resistance is 5/5.
On exam, Bob is able to lift his arm on his own, but it is tender and tight at end range. When his muscle resistance is tested, his abduction and ER resistance is tender and hesitant. Passive end feel of Bob’s left shoulder is tight and pliable, no hard end.
