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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