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Clinical Cases Typical cases of PPP

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Old 17-03-2005, 11:00 AM   #1
nari
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Yesterday I saw a bloke in his late fifties, 22 months after he was hit by a front-end loader when it came down off a collapsed jack. These gadgets are pretty heavy, and it glanced his (R) shoulder, loin and hip.
He has now persistent pain down his (R) side - head, neck, arm, hip, knee and foot. It is creeping towards his left side as well.
He had soft tissue injuries and spent a long time in Rehab in Sydney.
He lives alone, on 28 acres, fifteen minutes out of a tiny village, totally isolated. He is able to drive for about twenty minutes before having to stop and rest; he cannot stand still for more than 3-5 minutes; he can sleep for 2-4 hours a night at best. To cope with this sleep deficit, he snoozes on and off during the day, mostly in the afternoon, doing all the chores in the morning.
When he took off his lightweight shirt (it is summer here), he winced. (He is a country fellow, tough and resilient) It wasn't anything to do with ROM, though that is restricted, it was the sensation of the material moving across the skin of the CTJ and shoulder. Allodynia plus. That is his pain, the skin was picking up everything that came near him, including wind, cold, heat, water..anything.
I decided to be a bit bold and look at his sensitivity. (I rarely bother with ROM now). He could painlessly flex his wrist and fingers, provided I kept his shoulder elevated; but 10 degrees into abduction the pain zipped through the arm. he could not tell whether it was distal to proximal or vv.
So I had a thought about Diane's posts on the skin and got him used to a steady. calm pressure on his shoulder and scapula. in the direction of up towards his neck. When he became accustomed to that touch (and he wasn't impressed at all to begin with) he tolerated it well. He was then able to move into 80 degrees abduction and complete ULNT3.

I thought about taping, but I wasn't going to see this guy again (impractical) and he could not possible manage the taping by himself. So after a bit of digging around in the brain (mine), I got him applying cephalad pressure with his left hand. It seemed to work; and once he got the hang of what I was trying to achieve, he figured it was a good idea.

He also said he would fiddle around with the hip and see if he could do some desensitising there as well.

He left for the next review (it was in a pain clinic) and felt better. he had put his shirt back on with more ease.

What would you guys have done?

Diane...thanks for the inspiration!



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Old 17-03-2005, 12:40 PM   #2
Diane
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Wow, Nari, how exciting! Are you going to turn into a hands-on-er? :lol:

I would have probably taped him, even if I weren't seeing him again. I would have thrown strips on him this way and that until he had good movment without hands on him, just with the tape.

The thing is, the brain would have kept normalizing over the next 3 or 4 days, reinforcing the pain free behavior. It would have had to be just a few strategic strips though, that he could reach to remove if need be, itchy skin or whatever. Rare, but it does happen once in awhile, even with Kinesio tape.
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Old 17-03-2005, 11:32 PM   #3
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Don't know about being a hands-onner, Diane, and destroying my carefully contrived image of hands-off!!

I guess I could have tried taping...just had visions of the poor guy trying to rip it off with a skin reaction going on...will do that next time, I think.
I have never heard of kinesio tape, so will try and find out what it is about.


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Old 18-03-2005, 02:45 AM   #4
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I've raved about it several times.. it's made in Japan, was designed by a chiropractor there it is rumored.. I've only ever been able to find it online. It's expensive, but worth the price because it is so comfy, breathes, stretches etc. and is still waterproof.. well, it gets wet but doesn't fall off.. take a little while to dry. You can buy a more waterproof type for hands..

Check out if it's available in Aus. I order it through Jim Humble in New Mexico, best price even in US dollars with customs tax.
Cheers,
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