UCP/Al/11/219

Case presentation

Musculoskeletal module.

Subjective Examination

Personal information of the patient Name- X

Age- 53Gender- FemaleOccupation- HousemaidPosition in the family -Married Has 3 children

History of present complaints- 2 months ago, when she was raising her arm, pain appeared over the right shoulder.Then her shoulder over head movement was gradually limited by the pain

Present complain- Pain over right shoulder. Shoulder is unable to raise. When doing something using her right UL, gets pain. It remains about 1min & lost. Difficulty in performing activities of daily life - combing hair

dressing lifting a weight

The pain is often worsened by shoulder overhead movement and at night, especially if the patient is lying on the affected shoulder.

Onset of the pain- Gradual onset of the pain

Site of the pain-pain over the right shoulder joint

How long has the problem existed- For 2 months

Nature of pain- Dull aching pain, localized

Aggravating factors-Become worsened when attempting to move through the mid range of the abduction when lying on the affected side Pain worsen at night.

Past medical history -Suffering from hypertention diabetics and taking medications.

Objective Examination Observation

Informal observation–

Gait – Normal

Formal Observation – Patient is observed from front, side, and back while she is sitting and standing

1).Posture and bony contours Alignment of head-Normal Shoulder girdle level-Slight elevation of right shoulder Spinal posture-Normal

2).Soft tissue contours and muscle form no muscle wasting is observed3).Skin colour Normal

Palpation Skin temperature - Normal Tenderness - No Swelling - No Muscle tightness - Upper trapezius

TestsNeck Compression test Lateral compression testShoulder Neer’s impingement test Drop arm test Empty can test Infraspinatus test Speed’s test Lift-off test

Measured ROM of shoulder jointMovement Right side

AROM PROM

Left side

AROM

Abduction 165 175 175

Flexion 158 160 180

Extension 57 60 60

Medial Rotation 67 68 70

Lateral Rotation 85 88 88

Muscle Testing

Muscle group Muscle power

Right side Left side

Flexors 4 5

Extensors 5 5

Abductors 4 5

Adductors 5 5

Medial rotators 5 5

Lateral rotators 5 5

Pain measurement

According to Visual Analog Scale - Severe pain 7.5

Physiotherapy diagnosis Patient’s shoulder abduction during the mid range of the motion is painful.

So the abduction is limited.

Neer’s impingement test is positive

Painful arc syndrome due to supruspinatus tendinitis

Treatment Plan Aim - Reduce pain Restore the ADL & range of motion

Objectives To relieve the pain To increase the ROM To reduce muscle spasm To restore general muscle strength

01. To relive pain , muscle spasm-Ultra sound therapy,4min,2 times per week Increased heat causes vasodilation reducing muscle ischaemia, this heal muscle spasm, reducing pain(counter irritation),prior to the exercises.

02. To improve the ROM-1. Exercise therapy Active range of motion exercises for shoulder jointa). It helps to maintain the mobility and flexibility.b). Restore the ROM.Relaxation exercises - to increase ROM

2. Soft tissue mobilization to reduce muscle tightness

03. To improve muscle strengthResisted isometric movements for all the rotator cuff muscles.15 times a session. 3 times a week for strengthening the weak muscles gradually.

Movement 1st session measurement(AROM)

2nd session measurement(AROM)

3rd session measurement(AROM)

Abduction 165 167 168

Flexion 158 159 163

Extension 57 58 59

Medial rotation 67 68 70

Lateral rotation 85 85 87

Progress

Tools of measurement: Goniometer Visual Analog Scale

Thank you….