Case presentation 202 finaal

CASE PRESENTATION

UCP /AL/11/202

SUBJECTIVE EXAMINATION

PERSONAL INFORMATION

Name : X Age : 49 years Gender : Male Occupation : Unemployed . Earlier

technical supervisor in Dubai . Civil Status : Married Family details : Has 3 children

PRESENT COMPLAINS Deep aching pain in left shoulder since 4

months. It’s gradually onset pain. Pain location:Pain over the acromion

process to deltoid insertion area. Pain is worst at night Pain is aggravated by lifting weights and

sudden movements of shoulder.

Due to pain and stiffness cannot engage the ADL such as combing hair

weight lifting unable to reach high shelves Specially he’s unable to go to his job

due to his painful shoulder.

Past medical history : DM + , HT + Past surgical history: None

OBJECTIVE EXAMINATION

Observation Observed from anteriorly , posteriorly &

laterally in sitting and standing position. Colour and texture of the skin is normal

and no scars. No swelling around shoulder region. Left shoulder is higher than right

shoulder. No muscle atrophy.

Palpation Tenderness over supraspinatus tendon &

deltoid muscle. No tenderness over cervical region. No muscle spasms. No muscle tighgtness. No altered temperature around shoulder.

Tests A-ROM Right Left Shoulder flexion 160 140 Shoulder extension 55 35 Shoulder abduction 175 60 med: rotation 60 25 Lat: rotation 80 45

Neck & elbow movements are normal . No any pain

MUSCLE STRENGTH OF SHOULDER REGION Right Left Shoulder extensors 5 4 Shoulder abductors 5 3 Shoulder flexors 5 3 Shoulder adductors 5 4

TESTS Speed test – Negative Yergoson test-Negative Empty can test – positive Supraspinatus tendinitis test – positive

Pain according to VAS - 8

DIAGNOSIS Adhesive capsulitis

Supraspinatus tendinitis

Shoulder movements are restricted due to pain and stiffness.( due to adhesive capsulitis and supraspinatus tendinitis)

PLAN OF TREATMENTSShort term goals Relief pain Reduce inflammation Increase ROM Increase muscle strength Maintain soft tissue and joint integrity

mobility Prevent adhesions Advice and reassure the patient Reeducation of functional movements

Long term goals Restore shoulder movement in order to do

activities of daily living (ADL)

TREATMENTS IR therapy -15 mins-trice a week

Reduce pain and relax the muscles. Ice therapy- 10 to 20 mins-before bed

Reduce night pain. Ultrasound therapy – 1MHz , 4mins,0.8

W/CM-2- Over supraspinatus tendon

Facilitating removal exudates and reduce inflammation. Pendulum exercises To relieve

pain through gentle traction and oscillating movements , Relax the muscles , Mobilize the shoulder

Passive ROM exercises- in all ranges of pain free motion Maintain soft tissue and joint integrity mobility

Accessory movements - grade I & II oscillatory movements – pain relief -grade III & IV oscillatory movements – increase ROM -longituidanal, anteroposterior, posteroanterior directions Soft tissue manipulation -Friction-tranverse friction applied to supraspinatus tendon-to mobilize the tendon, adhesions are softened and streched Active assisted and active movements-

increase ROM , increase joint mobility- 10 repetitions twice a day

Strengthening exercises –with and without weight

Shoulder girdle, neck & elbow mobilization exercises

Advices-don’t sleep on affected side

JUSTIFICATION Pain- limit movements , decrease the

quality of life- therefore used IR therapy ,ice therapy , manipulation techniques

Increase ROM- all the movements are limited, unable to do day to day life activities – therefore used accessory movements ,ROM exercises , mobilization exercises

Muscle strengthening –stiff and painful joints

movement limitation muscle wasting- have to do strengthening exercises Re educate the muscle function-he used to

perform ADL by unaffected hand , so have to re-educate activities

OUTCOME MESUREMENTS AFTER 4 DAYS RANGES IN DEGREES A-ROM Right Left Before Shoulder flexion 160 150 140 Shoulder extension 55 40 35 Shoulder abduction 175 80 60 med: rotation 60 30 25 Lat: rotation 80 52 45

Pain according to VAS-5 Muscle strengthening of left shoulder Before After Shoulder extensors 4 4 Shoulder abductors 3 4 Shoulder flexors 3 4 Shoulder adductors 4 4

THANK YOU