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MSK Module
Case study
UCP AL/11/220
CASE PRESENTATION
UCP AL/11/220
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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
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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
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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
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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
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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
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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
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Physiotherapy diagnosis
• Reduced range of motion in all movements of S/J due to pain and stiffness ( Can be due to frozen shoulder)
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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
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Long term goals
To Increase ROM
• Active assisted ROM exercises
• Self mobilization exercises
Posterior glideAnterior glideCaudal glide
Abduction adduction flexion Internal rotationExternal rotation
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• 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
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• Pendulum exercises
• Increase muscle power; strengthening exercises
deltoid
triceps
biceps
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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
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THANK YOU