Joint Subluxation and Enthesitis

I've had PsA for almost 25 years with minimal discomfort. However, in the past year it has gone into overdrive

For the past few months I've had sharp intermittent pain in my shoulders. Here is an example of what happens with me. In the middle of the night I can reach out to move the bed covers and my shoulder will sublux and I've sometimes screeched with the sudden severe pain. If I reach down into the bathtub to close the drain (a down and twisting movement), I'll get the subluxation. Ouch! Putting on a jacket requires slow steady movements to prevent the sublux.

My Rheumy said it was tendonitis and sent me to PT for 3 months. Unfortunately, none of the therapists had ever worked with a PsA patient...this really surprised me. Anyway, it wasn't until close to the end of the 3rd month that the therapist figured out what was going on with me. He said my shoulders are subluxing and I have enthesitis. I learned that subluxation means coming out of joint partially and temporarily. He said I also have tendons in the shoulders that don't glide across one another as they should. They sort of pop across which is more uncomfortable than painful.

I was wondering if this is common in PsA...is anyone else dealing with this?

Thanks all! :)

So it took the therapist 3 months to agree with your Rheumys diagnoses?? Amazing.

This sort of highlights one of my pet peeves PTS who think first they are smarter than the Doctors who prexcribe them (there are some dumb docs, but thats a different discussion) and second try to do what is way beyond their skill set; Diagnoses and worse joint manipulation. There are even some who attempt some of the things chiropracotors do (despite they have hours of introduction as opposed to years of training) You'd be better off having Bubba next door "snap your back?"

Sublexation is reasonably normal. (sublexation without pain is called "double jointed") The reason a doc would send you to a PT is to stretch those tendons pretty much to avoid what you are talking about. Enthesitis is a subset of tendonitis.

So dealing with the pain you described ? Yeah, that's one of the primary symptoms (and more easily dealt with) parts of PsA. Dealing with ignorant therapists who aregenerally easy to spot (they claim to know than someone else) sadly is also part of it.

Remember you have a 50 -50 chance of dealing with someone who graduated in the bottom half of their class. Best of luck PT does help, but takes months (like everything else with this stupid disease) to really make a difference.

It may be that you are finally getting there and inflammation is down enough that your PT can finally see whats going on.

Anna,

This is what happens to me as well! My shoulders are the worst! My Rheumy told me that I have AS and a bit of Hypermobility . I also have that tendon thing going on in my right knee. I did have PT for it last year and I think I may have to go back. I had an MRI done but it showed nothing...

Thanks for the input!

Westee, do you have PsA and AS both? I've wondered if I've been given the correct diagnosis because my symptoms seem to overlap several of these types of arthritis. My pain is almost exclusively bilateral and I've read that bilateral pain is not common with PsA.

I've also been curious how a PT could have never even heard of PsA. I guess we'll just all keep learning more about it all. :)

tntlamb said:

So it took the therapist 3 months to agree with your Rheumys diagnoses?? Amazing.

This sort of highlights one of my pet peeves PTS who think first they are smarter than the Doctors who prexcribe them (there are some dumb docs, but thats a different discussion) and second try to do what is way beyond their skill set; Diagnoses and worse joint manipulation. There are even some who attempt some of the things chiropracotors do (despite they have hours of introduction as opposed to years of training) You'd be better off having Bubba next door "snap your back?"

Sublexation is reasonably normal. (sublexation without pain is called "double jointed") The reason a doc would send you to a PT is to stretch those tendons pretty much to avoid what you are talking about. Enthesitis is a subset of tendonitis.

So dealing with the pain you described ? Yeah, that's one of the primary symptoms (and more easily dealt with) parts of PsA. Dealing with ignorant therapists who aregenerally easy to spot (they claim to know than someone else) sadly is also part of it.

Remember you have a 50 -50 chance of dealing with someone who graduated in the bottom half of their class. Best of luck PT does help, but takes months (like everything else with this stupid disease) to really make a difference.

It may be that you are finally getting there and inflammation is down enough that your PT can finally see whats going on.

Yes, my Rheumy thinks I may have both because I have always had a lot of pain in my spine. It used to be just my lower back but it is now in my upper back and shoulders/neck. I also have slight scoliosis. I have heard the opposite - my pain is on both sides. Right now, my right knee is really hurting and I may get an injection when I see the Rheumy on Thursday. If I wait, I have to pay him for another visit just for that.

I am going to ask him what might be in store for me in the years to come. I learn more about this disease from other sources although I think it is just because I forget what to ask once I'm in the office!

This is a good book to buy: Psoriatic Arthritis: The Facts by Dafna Gladman and Vinod Chandran.


AnnaMcF said:

Thanks for the input!

Westee, do you have PsA and AS both? I've wondered if I've been given the correct diagnosis because my symptoms seem to overlap several of these types of arthritis. My pain is almost exclusively bilateral and I've read that bilateral pain is not common with PsA.

I've also been curious how a PT could have never even heard of PsA. I guess we'll just all keep learning more about it all. :)

tntlamb said:

So it took the therapist 3 months to agree with your Rheumys diagnoses?? Amazing.

This sort of highlights one of my pet peeves PTS who think first they are smarter than the Doctors who prexcribe them (there are some dumb docs, but thats a different discussion) and second try to do what is way beyond their skill set; Diagnoses and worse joint manipulation. There are even some who attempt some of the things chiropracotors do (despite they have hours of introduction as opposed to years of training) You'd be better off having Bubba next door "snap your back?"

Sublexation is reasonably normal. (sublexation without pain is called "double jointed") The reason a doc would send you to a PT is to stretch those tendons pretty much to avoid what you are talking about. Enthesitis is a subset of tendonitis.

So dealing with the pain you described ? Yeah, that's one of the primary symptoms (and more easily dealt with) parts of PsA. Dealing with ignorant therapists who aregenerally easy to spot (they claim to know than someone else) sadly is also part of it.

Remember you have a 50 -50 chance of dealing with someone who graduated in the bottom half of their class. Best of luck PT does help, but takes months (like everything else with this stupid disease) to really make a difference.

It may be that you are finally getting there and inflammation is down enough that your PT can finally see whats going on.