K . A . N . K . K . A R A C H C H I

U C P / A L / 1 1 / 2 0 6

CASE PRESENTATION

SUBJECTIVE EXAMINATIONPERSONAL INFORMATION

• Name: X

• Age : 57years old

• Gender: female

• Occupation: retired clerk

• Position in the Family :mother of one son

HISTORY OF PRESENT COMPLAINS

• No history of trauma

• Pain in upper shoulder level gradually spreads down

to elbow and to the neck

• Type of pain :Aching deep dull pain

• Location : over left shoulder

• Onset :Gradual onset for 6 months

PRESENT COMPLAINTS

• End ROM pain

• 24- hour behavior of symptoms-Pain disturbs sleep

• Aggravating factors

hand behind back

above head activities

lifting weight

• Easing factors

• Supporting the weight of the arm

Past medical history: suffering from diabetes & following

medications

OBJECTIVE EXAMINATION• Observation

Informal observation

she looks like a healthy woman but sad in mood due to

her shoulder problem.

Formal observation

observe from Anteriorly, Posteriorly, Laterally in both

sitting & standing positions.

-a shoulder hike is seen in right shoulder

- -rounded shoulders

-poking chin

-No changes in muscle contours

no abnormal skin discoloration

-no scar

PALPATION

• Tenderness over left acromioclavicular area

• Tight upper fibers of trapezius

• No local skin temperature difference

TESTS

• All AROMs & PROMs of

left shoulder joint are

limited.

• According to VAS pain scale

pain = 6

TESTS

Muscle power (Oxford medical research center scale)

Muscle group grade

flexors 4

extensors 3

Abductors 3

adductors 4

External rotators 3

Internal rotators 3

Functional assessment

eating

combing hair

put something on shelf

brushing teeth

TESTS

Shoulder

• Drop arm test (-)

• Empty can test (-)

• Speed test (-)

Neck

• compression test (-)

• Lateral compression test (-)

Elbow

• Mills test (-)

PHYSIOTHERAPY DIAGNOSIS

• Sharp pain at the limit of all active and passive

movements due to stiffness characterizes adhesive

capsulitis

PLAN OF TREATMENT • Short term goals1. relieve pain (IR for 15 min. twice a week)

2. increase the ROM

• free active exercises (pendular/auto assisted elevation/towelling action)

3.Reduce stiffness in shoulder joint

• Accessory movements(postero anterior/anteroposterior/caudal glide)

4.Relaxation

• hold relax/soft tissue massage/stretching

• Finger kneading on tender spots of upper trapezius

• Long term goals

1.to increase muscle strength

2.to restore posture

• shoulder girdle retraction &depression

practice

• advice (not to sleep on affected side/to follow

exercises at home)

• 3.To restore shoulder joint

movements to regain normal ADLs

JUSTIFICATION OF TREATMENT

Movements are limited by pain and joint becomes stiff

later.so pain & stiffness has to be reduced

As all the GH movements are limited, should increase ROM

Adhesion formation in the joint further restrict movements

and it progress to the muscle wasting

So muscle strengthening should be.

As shoulder girdle elevated due to pain, tight upper trapezius

should relaxed to get rid of muscle spasm.

OUTCOME MEASUREMENTS OF THE INTERVENTION

Session 1 session2

Flexion 60 72

Extension 28 30

Abduction 42 57

Medial rotation 28 33

lateral rotation 22 28

Improvement of movements

At 2nd session of patient's assessment , pain score has reduced

to 4 of VAS scale