Upper back shoulder complex testimony

[Guest guest]

I have a pt. who was hurt in a side collision accident where she hurt her

neck, upper back, low back, ribs on both sides, etc.

I treated her over the next 2 years or so with pretty good but frustratingly

slow results.

Here is a conundrum:

She is around 55 years old, athletic, mildly kyphotic, and works over a desk

doing commercial levels of artistic painting.

Her upper back is about as hard to adjust as a cement carrier and I am

pretty good at adjusting; especially people who weight 50 lb. less than me.

So along comes some worsening shoulder pain which I had occasionally noted

but attributed to her job and stubborn upper back injury. (i.e. You have a

wounded neck and upper back which irritates the nerves to the brachial

plexus. You have to hold your arm steady to do accurate, fine work, or hold

a mouse, and your shoulder feels fatigued, tires easily, and even painful

intermittently.)

Now I'm asked to comment on why the shoulder took so long to manifest.

A fairly recent MRI shows traumatic bruising of the humeral head verifying

that it really was smacked in the accident. She has since had a surgical

repair of her rotator cuff which had helped her upper back and neck

immensely. She has improved and comes in every other week or so for

maintenance care.

On one hand, I wish I had noticed her rotator cuff was as bad as it was

sooner to help her neck and upper back. (My wife thinks I have the scruffy

beard, giant intellect [OK, I threw that in] and sarcasm so I should just

present myself as Greg House, M.D. And make incisive comments that medicine

is both art and science and only lawyers know how you should have seen

things coming 100% of the time. My wife wants me to get killed in there.)

On the other hand, the patient's upper back style/temperment/nature may have

masked the shoulder aspect.

The surgeon was pretty forgiving. He read my notes and said that he would

have recommended conservative care as was delivered, for as long as it was

delivered, before doing an MRI and looking for shoulder damage. (What a

guy!)

I'm writing this for feedback on

stiff-kyphosis-and-injury-in-an-otherwise-healthy person syndrome.

Also to describe it and see if it makes sense as I am testifying about it

soon.

As I write this, it does make sense that I would have mistaken her shoulder

pain for cervicogenic TOS-like symptoms.

It is also notable that various holidays gave her a break for things to

quiet down and fool us in her recovery and other activities aggravated it.

Also writing as a reminder to ya'll that sometimes routine cases can be

called to trial and you may be asked to defend your assessment and approach

to care.

Any feedback would be appreciated and read with zest by many people who

rarely lend their insight to the discussion.

By the way, we have rules about forwarding our communication without

permission. There is another rule that is not in writing that says, " anyone

found to have forwarded someone's email to anyone in a pending trial can

have their jersey pulled over their head and be beaten to within an inch of

their life. "

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com