Case Presentation(Musculoskeletal

Module)

M.I.M AyazUCP/AL/11/187

Subjective ExaminationPersonal Information• Name : Mr. X• Age : 57 yrs• Gender : Male• Occupation: Bus Driver• Address : Kelaniya• Civil Status: Married• Children : 2 sons and a daughter• Health Risk : DM+

History of Present Complaints• 2 yrs ago, when he was driving the bus he

suddenly felt a sharp pain over the left shoulder and had a difficulty to change the gear.

• But after having some analgesic drugs it disappeared and rarely present.

• 2 months ago when he was lifting his grand daughter severe pain occurred over the same area.

• Pain has increased gradually.

Present Complaints• Severe aching pain often present around the left

shoulder joint.• Sometimes it reffered to the lateral aspect of the

arm• Difficulty to perform day to day activities Eg : Unable to sleep on the affected side. Difficulty to lift heavy weights by the affected side.

Objective ExaminationObservation

• Informal Observation : Looks like a healthy man with slightly depressed mood

• Formal Observation : Had been done by looking at the patient anteriorly, laterally and posteriorly while he was in sitting as well as standing.Scapula levels were equal, slight prominent acromian process of left side, slight muscle wasting of left side (deltoid & supraspinatus), No skin colour changes, little bit swelling around the left acromian process

Objective Examination Cont…Palpation• Tenderness below the left acromion process• Pain increased with palpation• Slight Muscle spasm over the Left shoulder area• Left acromion was prominent• No temperature changes

Test

AROM

PROM

Muscle Power

Spec. Test

Objective Examination Cont….Test

Mobility chart of the Shoulder Joint taken on

07/02/2015

MovementNormal Range

Right Side Left Side

(X °) Active Passive Active Passive

Flexion 180 180 - 180 180

Extension 60 60 - 40 55

Adduction 45 45 - 35 40

Abduction 180 180 - 73 140

Internal Rotation

70 70 - 60 70

External Rotation

90 90 - 52 85

Measured ROM of other relative joints• Neck Movements Normal• Elbow Joint Normal• Wrist Joint Normal

Muscle power testing according to the muscle grading scale (Left Side)• Flexors– 5• Extensors – 5• Abductors – 3• Adductors – 5• Internal Rotators – 5• External Rotators - 4

Special Tests• Speed Test -ve• Drop arm Test -ve• Anterior and Posterior drawer Test *• Supraspinatus Tendinitis Test +ve• Apley Scratch Test +ve• Hawkings kennedy impingement Test +ve

Physiotherapy Diagnosis : Supraspinatus Tendinitis of Left Shoulder Region, secondarily Frozen Shoulder

Treatment PlanObjectives• Relieve the pain• Increase the ROM• Reduce Muscle spasm• Restore general muscle strength• Prevent Recurrence and Educating the patient

Short Term Goal – Relieve the painLong Term Goal – Bring the patient back to the normal functional level

Treatment Plan cont….At Early Stage• Ultra Sound Therapy – continious mode, 0.8 W/cm2, 4 min, 1 MHz, thrice a week• Soft Tissue Mobilization - Transverse friction to the area• Ice therapy – after the transverse friction• Active Exercises

At Final Stage• ROM Exercises• Relaxation Exercises• Muscle Strengthning Exercises

Justification of the treatment plan

• Ultra Sound Therapy to relive pain, increase circulation, increase removal of waste products and as a micro massage

• Transverse friction to break adhesions• After friction cryotherapy can be given to warmth

area • Active Exercises /AROM Exercises to improve

ROM, to improve muscle properties and to prevent forming contractures

• Relaxation Exercises to increase joint mobility• Strengthning Exercises to Strength weak muscles

and improve muscle power• Educate the patient to get the cooperation for the

treatment plan

-Thank You-