case ppt. manish

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DEMOGRAPHIC DATA

� Name: Javed Khan

� Age/Sex: 25/Male

� Profession: Cricketer- Allrounder, playing since 12to

13 years, two and half hours/day, 4days/week

� Balling- Right Arm Off Spinner

� Occupation: Architect

� Address: Jui Nagar

� Dominance: Right Side

� Chief Complaints: Pain in the right shoulder during

over arm throwing activity



PAIN HISTORY

� Type :-

� Site :- Posterior to AC joint

� VAS :- 5/10

� Aggravating Factor :- Throwing

� Relieving Factor :- Rest



History

� HOPI :- Patient was apparently alright one and half

months back when he suddenly felt jerk in his rightshoulder while throwing. At that time there was no

pain, but the very next morning he started feeling

pain in right shoulder and was unable to lift his arm.Patient applied ice and took rest. He didnt practice

for 10 to 15 days and gradually pain subsided. At

present pain is only during over arm throwing. No

complaints of pain while bowling or batting. To avoid

pain his doing only underarm throw at present.



HISTORY CONTD«

� Past history :-

No history of occurrence of same kind of pain before

� Medical History :-

No medication taken

� Personal History :-

-No addiction

-Appetite :- Good

-Built :- good

-Sleep :- normal

� Vitals :-Normal



On Observation

� GC :- Good

� Posture :-Head slightly side flexed to right, rightshoulder depressed, medial border of scapula

prominent.

� Wasting :- not evident� Hypertrophy:- Not Evident

� Skin Changes :- Not evident

� Swelling :- Absent



On Palpation

� Tenderness :- Positive

� Trigger Point :- Supraspinatus, upper trapezius

� Bony Prominence :- palpable, non-tender

� Temperature :- Normal

� Tissue texture :- Normal



On Examination

� Sensory :- Normal

� Motor

- ROM :-

Joint Movement Right Left

Shoulder Flexion 175 180

Extension

Abduction 180 180

MR 65 85

ER 115 90

Elbow 125 130



Medial Rotation Lateral Rotation



- MMT :-Muscle Right Left

Deltoid 4 4

Bicepes 4 4

Tricepes 4 4

Supraspinatus 4 4Infrasspinatus 3 4

Teres Minor 4 4

Pect. Magor 4 4

Lattismus dorsi 4 3

Rhombodis 4 4

Trapezius 3 4

Serratus ant. Good Good



- TIGHTNESS :-

Muscle Right Left

Pect. magor Mild Absent

Int. rotators Mild Absent

Ext. rotators Absent Mild

Latti. Dorsi Absent AbsentBicepes Mild Absent

Post. Capsule Mild Absent

Inf. Capsule Mild Absent



� Special Test :-

-Impingement test :- Negative

-Musculotendinous test :- Negative

-LSST :- Difference 0.5cm

-GIRD/GERG :-



� Differential Diagnosis

- Impingement Syndrome

- Rotator Cuff Tear

Diagnosis :-

Scapular dyskinesia



LSST:-



Management

Throwers Rehabilitation :-

� Phase I :- (Acute phase)

- diminish pain and inflammation

- normalize or improve motions and flexibility

- retard muscular atrophy

- enhance dynamic stabilization



Rehab Contd«

� Phase II :- (Intermedaite phase)

- Improve muscular strength and endurance

- Maintain or improve flexibility

- Promote concentric-eccentric muscular training

- Maintain dynamic stabilization and neuromuscular

control



� Strengthening Exercise

Middle Trapezius Lower Trapezius

Serratus Anterior



Rehab Contd«

� Phase III (Advanced phase)

- Initiate sport specific training

- Enhance power and speed (Plyometrics)

- Maintain rotator cuff strength program

- Improve muscular endurance



Rehab Contd«

� Phase IV (Return to activity)

- Return to sport activity

- Maintain strength, power, endurance and

flexibility gain



Follow Up :-

ROM :-

MMT :-

Movement Right Left

Medial Rotation 80 85

Lateral Rotation 105 90

Muscle Right Left

Infraspinatus 4 4

Trapezius 4 4



Progression :-

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