115. Shoulder pain & weakness - diagnosis and detective work. Physio Edge Shoulder success podcast with Jo Gibson
Mar 19, 2021
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Clinical Physiotherapy Specialist Jo Gibson discusses a case study of a man with shoulder pain & weakness, highlighting the diagnostic challenges. Key topics include uncommon shoulder pain presentations, impact of symptoms like difficulty smiling, recommended tests, muscle weakness, long term prognosis, evidence-based treatment, and involvement of medical specialists in diagnosis. The podcast aims to enhance physiotherapists' skills in assessing & treating stiff shoulders.
Differentiate uncommon shoulder pain presentations for accurate diagnosis.
Understand the impact of muscle weakness on shoulder function, indicating potential neuromuscular disorders like fascioscapulohumeral dystrophy.
Deep dives
Key Rehab Challenges in Shoulder Pain Patients
Jo Gibson, a clinical physiotherapy specialist, discusses a case study of a 21-year-old gym enthusiast who developed shoulder pain and asymmetry in the scapula. Despite no significant neurological symptoms, he struggled with maintaining his arms above shoulder height. Upon examination, he exhibited marked scapular winging and trapezius weakness, indicating a potential diagnosis of fascioscapulohumeral dystrophy, a neuromuscular disease that presents with facial weakness and progressive muscle wasting.
Diagnosis and Clinical Features of Fascioscapulohumeral Dystrophy
Fascioscapulohumeral dystrophy is a rare muscular dystrophy that commonly manifests in adolescence, affecting facial muscles leading to difficulty in smiling and drinking from a straw. Clinical signs include inability to fully shut eyes, asymmetrical facial expressions, and reduced eyelash burying ability. Muscle weakness in the lower trapezius and serratus muscles causes scapular winging, with variations in disease progression among patients. Genetic testing is crucial for diagnosis and counseling, revealing familial history in 60-70% of cases.
Treatment Challenges and Options for Fascioscapulohumeral Dystrophy
Treatment for fascioscapulohumeral dystrophy remains challenging, with scapular thoracic fixation surgery as an option for severe functional restrictions. Bracing may be poorly tolerated, and evidence on targeted muscle strengthening is scarce. Management often focuses on graded activity and avoiding intense exercise to prevent muscle damage and progression. Patients can access resources from the Fascioscapulohumeral Dystrophy Society for support, genetic testing for diagnosis, and counseling on disease progression.
Community Engagement and Continued Learning
The podcast engages the community in a case study discussion on fascioscapulohumeral dystrophy, highlighting the importance of recognizing unique conditions like bilateral muscle wasting. Clinicians are encouraged to seek specialist referrals for genetic testing and accurate diagnosis. Resources provided include articles examining gene expression and clinical features, emphasizing the need for early detection, appropriate management, and ongoing learning in the field of musculoskeletal physiotherapy.
Time for some detective work - can you diagnose the cause of this man’s shoulder pain? Listen out for the clues in this interesting case study.
When your shoulder pain patient has bilateral shoulder pain after starting a gym program, difficulty lifting their arms overhead due to weakness, significant bilateral scapular winging and muscle atrophy, what are your potential diagnoses?
Find out in this case study with Jo Gibson (Clinical Physiotherapy Specialist), and discover:
When patients have uncommon shoulder pain presentations, what potential diagnoses can you keep in mind?
How does it impact your diagnosis if your patient has difficulty smiling, whistling and drinking through a straw?
What’s this patients’ diagnosis?
What tests can be performed to confirm the diagnosis?
Which muscles are commonly affected?
How much muscle weakness commonly occurs?
What is the long term prognosis for this condition?
What treatment is supported by the evidence?
Are braces helpful?
Which medical specialists are important to include in diagnosis & management?
Podcast handout
The handout for this podcast consists of articles referenced in the podcast. There is no additional transcript or handout available.
Free webinar “5 common mistakes therapists make with shoulder pain, and what to do about them” with Jo Gibson
Shoulder: Steps to Success online course with Jo Gibson
Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess