shoulder pain

I am a physical therapist with a pt that I am seeing for a second time for shoulder pain, but it is evident that her pain stems from her PM, as it moves with her shoulder, it seems to be adhered to the pectoralis muscle. The stretches and moist heat help but the relief tends to be temporary and the pain never goes completely away. Does anyone have any suggestions, any stretches? I am at the point of asking my pt to consider a second medical opinion since her MD wants to ignore the problem. I have seen a few remarks about pocket revisions, I wonder if this would be a more permanent fix? Any thoughts? Thank you in advance.

6 Comments

I had severe shoulder pain...

by pmekimrotut - 2008-08-04 04:08:31

...Took nearly two months for the swelling and soreness in the joint to subside. I had been on cumadin (sp?) for a month before ICD surgery, so it really swelled and took longer to heal. I thought I had a rotator cuff tear, but now it's getting better. It is my understanding that the cardio/surgeon has to pull around on the arm/shoulder sometimes to guide the leads to the proper place. I think that can cause some collateral pain.

I thought...

by turboz24 - 2008-08-04 08:08:30

"I can see a problem if it was sutured to a muscle rather than stationary tissue.". I thought that they did suture it to the pec muscle. I'm not sure what they would attach it to otherwise. Mine is sutured to my pec muscle.

Movement with muscle

by ElectricFrank - 2008-08-04 08:08:54

Hi,
Pacemakers have a Suture Hole that lets the surgeon stitch it to underlying tissue. It isn't always used or used properly. The purpose is to keep it from migrating under the skin. I can see a problem if it was sutured to a muscle rather than stationary tissue. Muscle movement would attempt to move the pacer inside a limited pocket area and pull on the sutures. This could be irritating to the muscle.
As for the MD ignoring the problem insurance rarely covers early repairs such as this so the it is to the docs advantage to put it off long enough to be a new procedure.

frank

Concern

by Suze - 2008-08-04 11:08:36


How good of you to be concerned about her well being, especially since her doctor isn't!
As far as I'm concerned she should get another medical opinion whenever a doc ignores ANY pain. Everything should be ruled out.
My husband went for physical therapy for shoulder and back pain. Since it didn't help (except temporarily) our doctor ordered an MRI. It turns out he has a mass on his spine between C7 and T1. He is going in for very serious surgery. If the medical people didn't look further than their original thought, he would suffer longer than necessary.
I wouldn't hesitate to suggest another opinion. Even if the original doctor is the one who sent her to you in the first place. Is that doctor a cardio or EP doctor?

shldr pain

by Montyhend - 2008-08-04 12:08:09

the doctor that sent her to me was her family MD, she reportedly has told her Cardio about the pain who reportedly stated that he wasn't going to replace it. It may be a communication problem since the pt speaks broken English. My first course is to communicate my findings to the referring physician and forward the report to her cardiologist. If the result remains nothing, then suggest a second opinion.

Another Medical Opinion

by auntiesamm - 2008-08-05 02:08:28

You are right to be concerned about your patient. I believe you can be her advocate and speak directly to either of her physicians - PCP or Cardio on her behalf. In your place I would not be comfortable continuing to treat her in view of this problem. It is well within your scope of practice and your professional obligation to contact the physicians to discuss your concerns and help her get an appointment. Does she go to a PM clinic every few months to have the PM checked by the nurse or PM rep? Is there any reason she cannot make an appointment and go see the Cardiologist. You should also put your concerns in writing to the physician/physicians. If you practice here in the US you know that old mantra about document, document, document. Let us know how you proceed with this patient. Good luck.

Sharon (So CA)

You know you're wired when...

You always have something close to your heart.

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