MSK Module

Case study

UCP AL/11/220

CASE PRESENTATION

UCP AL/11/220

Subjective examination

Name : Mrs. Karuna Manike Age : 68 Gender : F

Occupation : House Wife

C/O : pain & stiffness in over head reaching & taking right hand into back

Functional limitations: Difficulty in combing hair, applying soap on the b back when bathing

Onset: Gradual

Duration: 1 year

Dominant hand: right

PAIN

Location : over deltoid

Type : aching pain

Is the pain increasing/reducing : Increasing

Behavior of symptoms : pain increase with activity

Aggravating factors : sleeping on the affected side

Easing factors : neutral position of arm

VAS Scale

PMH: Knee OA, arteroscelosis, hypothyroidism

Objective examination

Observation:

Posterior view: right shoulder elevated than left

neck in slightly lateral flexion to right

Anterior view : ,,

Lateral view : Forward head

Chin to neck angle > 90

Rounded shoulder

Thyroid gland hypertrophy

Palpation

• Upper trapezius spasm

• Trigger points

• Right sternocleidomastoid spasm

ROM

Movement AROM PROM Normal

Flexion 90 120 180

Extension 50 50 60

Abduction 70 80 180

External rotation 70 70 90

Internal rotation 15 25 70

Horizontal adduction 85 70 135

Horizontal abduction 15 15 45

Conclution – reduced ROM in all movements

Muscle power

muscle Grade

Deltoid Anterior fibers 4

Middle fibers 4

Posterior fibers 4

Biceps brachi 4

Triceps 4

Rhomboids 5

trapezius Upper fibers 5

Middle fibers 5

Lower fibers 5

Pect major 5

Lattissimus dorsi + teres major 5

Tests

• Maitland's lock test: + (pain)

• Maitland's quadrant test : + (pain)

• Anterior apprehension test : + (pain)

• Hawkin Kennedy impingement test: pain

• Speed test : + (pain)

• Lippmann's test : + (pain on palpation)

Anterior drawer test, Posterior drawer test, Supraspinatus

tendinitis test, Drop arm test, Brachial plexus stretch test,

Tinnels sigs,Test for thoracic outlet syndrome are negetive

Glenohumeral dysfunction

Biciptal tendinitis

Physiotherapy diagnosis

• Reduced range of motion in all movements of S/J due to pain and stiffness ( Can be due to frozen shoulder)

Treatment planShort term goals

• Reduce pain : IR

• Trigger points: friction

• Correct faulty mechanics: manipulation- S/J caudal glide (grade)

& improve proprioception protected weight baring( progressed

with gentle rocking movement)

• Trapezius & sternocleidomastoid spasm : stretching

• Biciptal tendinitis: UST, stretching

• Pt education : Do not sleep on the affected side, don’t lift heavy weights from affected limb

Long term goals

To Increase ROM

• Active assisted ROM exercises

• Self mobilization exercises

Posterior glideAnterior glideCaudal glide

Abduction adduction flexion Internal rotationExternal rotation

• Manual stretching, progressed by self stretching

To increase horizontal abduction To increase lateral rotation

To increase flexion & extentionTo increase abduction & elevation

To increase extention

To increase internal rotation

• Pendulum exercises

• Increase muscle power; strengthening exercises

deltoid

triceps

biceps

Justification of treatment-

• Pt is an elderly so much stenos exercises are not encouraged

• Exercises are performed in much stable postures to prevent falls

Outcome measures: ROM, VAS scale

THANK YOU