Large lump at Ant. Deltoid/Bicep Head

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Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Tue Jan 18, 2005 8:44 am

I've been treating a client who has a large lump at the head of the bicep tendon (best we can tell) or at least the head of the humerus.   The lump changes size from time to time, sometimes larger (3 plus inches in diameter)  sometimes smaller, 2 plus inches.  It's elongated and on anterior arm. <br><br>Best I can describe it, it looks like a textbook picture of a torn long head of biceps, except that we know that anterior deloid is affected as well.  It refers pain to deltoid tuberosity.  And, it's not a torn bicep tendon.  Ext. rotation of shoulder is extremely limited but varies.  Ext. of arm decreased significantly as well.  Clients had this for YEARS and said that no one has been able to diagnose it, though she hasn't had an MRI. <br><br>She gets massage monthly from me only, but also has had aggressive accupuncture treatments that seems to help minimumly.  The size of the lump decreased for a time and mobility increased minimumly as well.  I can reach under the lump at the acromium process and biceps tendon and XFF/Linear F too and have some success with increasing ROM with Ext. rot.   Anyone out there know what this is?  It's as if ant. mm won't release to allow triceps to exend.
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby palpateit on Tue Jan 18, 2005 10:23 am

A few possibilities.<br>The long head of the biceps is encased in a synovial (tendon) sheath. The wrist/hand and ankle are the only other places this occurs.  When inflammation occurs its called tenosynovitis. The palcement and size sound about right.<br>The bicps tendon sheath is continuous with the shoulder joint (synovial) capsule.  If there's a problem here, inflammatory chemicals within the shoulder joint can migrate into the biceps tendon sheath.<br><br>Some texts describe 8 bursae of the shoulder joint. Some show a subacromial bursa and a subdeltoid bursa, and a deltoid bursa. Each bursa can be described as large or as small. It could be bursitis of one of these bursaes. His bursaes could be larger than "normal" or more anterior, or perhaps slipped anteriorly.<br>
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Tue Jan 18, 2005 12:32 pm

If that' the case, or if it is a torn head of biceps, sounds like massage will be helpful only on related structures.  I'd appreciate any other suggestions for tx within massage scope.  Thanks Palpateit
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Texas-gal on Wed Jan 19, 2005 2:55 pm

Clients had this for YEARS and said that no one has been able to diagnose it, though she hasn't had an MRI.  
<br><br>I think I'd want to know who "no one" is.  Is she talking about multiple docs, or just general people she mentioned her shoulder hurts to?<br><br>To be honest, if she's had it for years, and it looks like what you are describing, it would be best to send her to an orthopod have him do the work up and give you clearance to work on her.  You may loose the client (if for nothing else that she doesn't like you telling her this), but may save yourself some pain in the longrun (working with someone or something that you are not really sure of).  <br><br>Did she have any trauma in the past "years"?  I know I'd want to know an answer to that question.<br><br>Better to delve in deep now, than find a hidden item later.<br><br>Something I was just reading about today, a "non-displaced greater tuberosity fracture from 4 years prior (the guy complained of shoulder pain on and off for 4 years).  Couldn't see it on x/r, but it showed up on the MRI.  This has nothing to do with your case of course, except that the guy had pain for 4 years, and they just found it so many years later.  Something to think about regarding clients with longstanding complaints and no one has dx'd it.<br><br>Good luck on it! People like this always make me nervous!  *wipes a few beads of sweat from my brow*
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby melb on Wed Jan 19, 2005 9:13 pm

Err yeah, I agree with Texas-gal on the long standing pain.<br>I had a sore foot, had 2 different doctors tell me it was a pinched nerve (over the period of about a year) and was told to massage it myself, and go to a podiatrist and get an orthotic implant. Did that, hurt even more, but tried to keep using it, gave up.  Pain would get worse every now and then then gradually get better over a few weeks.  Eventually a doctor sent me off to a foot specialist.  One MRI later, turned out I had a confused bone full of cartilage rather than bone matrix and I was putting a fine fracture in it every now and then.  Massaging and orthotics were not the right thing to be doing to it....  This was the minor thing I've had mis-diagnosed, so I say make enough noise to get an MRI.....
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby lovingkindness on Thu Jan 20, 2005 2:03 am

I would not work the bicep area on this person until they had an MRI. It clears up any mystery and allows you work or avoid an area.  :)
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Thu Jan 20, 2005 8:07 am

Thanks for the input.  The woman is in her 50s and pretty much sworn off MDs.  But, when this first appeared she had been to at least one doctor.  She goes to chiro regularly too. Also, without health insurance, won't get an MRI.  I'm surprised that Accupunturists wouldn't know what it is.  I've been seeing her since 2003 and truthfully, I never detailed her account of this lump on my charts.  Her fibrom. has always been the focus.  <br><br>Up until I discovered this forum, I've been out here in semi rural CA by myself.  Most therapists in the area have little more than a 100 hours of training and no anatomy to speak of.  I'm transplant from the Seattle area and maintain my State license even though I've lived here for 4 plus years.   <br><br>My treatment on her is conservative, mostly related structures, but we've not made any real progress.  I've always felt that it was a torn head of the biceps but she doesn't remember any injury (might be withholding info too).  I've felt that this is certainly diagnosible and should be but some clients, as you all know, need their own time to heal.  She has Fibrom. as well, and clients conditions are not always what they appear.  She seems content with baby steps, if you know what I mean. <br><br>Reading what you all have to say has been great.  Confering with colleagues is such a great way to remind myself that I'm in tune with my intuition and that I remember more than I think from school back in 2000.  
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby palpateit on Thu Jan 20, 2005 9:17 am

. I can reach under the lump at the acromium process and biceps tendon


I guess I missed this part..... so you get deep to this object...at the acromion? Your fingers are deep the deltoid and this structure, AT the acromion - how is that possible?
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Thu Jan 20, 2005 10:51 am

I can slide my finger under the lump and massage mm attachments at the acromium process and feel the ropiness of the bicep tendon at the head of the humerus.  This lump is anterior, large, and not altogether hard.  I hope I'm explaining it well enuf.  If it were torn long head of biceps, would it feel that way?  Then the lump would be biceps kind of rolled up on itself?  I've never seen/felt torn head, so my earler conclusion that it's not torn head, was probably premature.  
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby palpateit on Thu Jan 20, 2005 4:08 pm

I can slide my finger under the lump and massage mm attachments at the acromium process and feel the ropiness of the bicep tendon at the head of the humerus.  


I still cannot visualize it.  I'm vizualizng You massaging DEEP to the deltoid attachments at the acromion. That is not possible. If your are next to the acromion, you must be superficial to deltoid. You sure you don't mean attachments at the coracoid process?
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Thu Jan 20, 2005 7:11 pm

Yes, thank you. Coracoid process, not acromium.  Sorry.  Does that help?
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby palpateit on Sat Jan 22, 2005 7:27 pm

No can't say that it does. Maybe your original thoughts on torn biceps tendon is it.  ???
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Re: Large lump at Ant. Deltoid/Bicep Head

Postby Manaworker on Sat Jan 22, 2005 7:37 pm

The upshot is this client is not about getting to the diagnosis, though she's turning to "alternative" methods to heal what she doesn't know it is.  I'm about figuring it out because that's me.  If the biceps torn, I can't fix it.  If it's bursitis, I can't fix it.  I'd love to have a more knowlegable therapist, or physical therapist be able to look at it, and say, yeah, it's a torn bicep. Thanks anyway,  I have other client conditions that I can bring to the forum.  
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