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January 17, 2007

Failing Arms

I've had two cases among my regular clients concerning arm pain and dysfunction.

First is a long-time client who has chronic arm and shoulder pain dating back to a job where they wired the cockpit of airplanes upside-down with their arms over their head. My usual protocol involves working the subscapularis muscles by accessing them under the armpit (remain lateral enough to avoid blood, nerve, and lymphatic structures) and at the top of the shoulder. I imagine I'm working the area until my fingers meet in the middle under the scapula. This work must be done slowly and with care because it can be exquisitely painful. Gentle stretches in all ranges of motion held for 12 to 20 seconds allows the body to relax into the stretch. Lately, however, my client cannot tolerate having the arm stretched over their head. Their neighbor, an orthopedic nurse, noticed them moving in a way that causes them pain and is suggesting they may have a rotator cuff problem. I'm strongly encouraging this client to see a doctor but their schedule makes them reluctant to open a can of worms that they fear would put them out of commission for several months.

Second is an older client who has traveling pain in their shoulder and arm when they lay down to sleep at night. It all started when they took a fall and caught themselves at a funny angle, hitting their upper arm on a chair. They experience no pain while standing and can do most activities in their exercise class. However, when the lay down to sleep at night, a deep ache settles in and prevents them from sleeping because they always have to change the position of the arm. When I work on them, I find tension in the upper trapezius, and working this muscle causes their pain to flair up. Every session the pain lands in a different place, is unbearable, and forces me to stop my work. Again, I strongly encouraged this client to see an orthopedist because their symptoms were a mystery to me. Happily we have a diagnosis of bursitis. Novocaine shots seem to have done the trick for this client and we are both so relieved that it is not something more serious. Their prognosis for recovery is very good.


Posted by linda at January 17, 2007 11:57 AM

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