04/19/2013S> AP, a 47 y/o (-) DM/Htn/Asthma handed pt c/o gr. 5/10 intermittent kirot at ngalay pain (0=no pain; 10= worst pain on SPS) on shoulder(on what area: front, back, sides) in simple movements (describe what kind of simple movements [simple movements with one patient may vary from another patient]) but to gr. 7/10 upon movement to endrange as to reaching overhead(what are the relieving factors/activites; describe and quantify if there is still pain); (L) lumalagatok knee c pain (what kind of pain and on what area of (L) knee : front, back, sides) @ gr. 3/10, pt claims pain is relieved c ice & sometimes subsides when playing basketball(aggravating factors and activities and describe type and quantify if there is pain). HPI: a mo. ago, pain was felt again on his shoulder(were there any activities that he did prior to the injury) & gradually until 2 wks ago, when he felt the pain was not tolerable anymore. He consulted a MD last April 12 & referred him to Dr. Reyes of MMC, where he was Dx c adhesive capsulitis on shoulder last April 17; no meds were given. X-ray was done but results were still to be read. PMHx: condition started last Jan 2012 during pts volleyball training, he spiked c his shoulder & felt something like a pulled muscle; placed ice pack right away. His coach advised him to take a 3-day rest, p resting, he exercised c a yellowish theratube for a wk & felt okay. Lifestyle: (-) alcoholic beverages drinker/smoker, works as an outside plant engineer, which requires driving, computer & office works. Pt still plays basketball during his spare time. Home & social environment: Pt lives c his wife & mom in a 2-storey house & claims he uses his (L) shoulder to reach their overhead cabinets; computer @ work follows proper ergonomics. Goal: Magheal ung sugat at makalaro nang maayos.O> VS> BP= a: 120/80mm Hg p:140/100mmHg OI>endomorph (-) redness of (B) UE (-) trophic skin changes on (B) UE (-) swelling & atrophy on (B) UE (anthropometric measurements) Palpation> (+) gr1 tenderness on bicipital groove area (+) crepitations upon shoulder ER&IR (-) muscle spasm on shoulder (-) muscle guarding on shoulder towards all planesAnthropometric measurements> (to objectively confirm that there were really no swelling and atrophy on B UE) ROM> All joints of (B) UE are assessed (and are WNL) and found significance c shoulder: (its better to include the findings on the (L) shoulder so we can compare it to the affected side)AROMPROMEndfeelFlex0-1500-160Firm c pain @ endrangeExt0-300-35Firm c pain @ endrangeAbd0-900-108Firm c pain @ endrangeER0-900-95Firm c pain @ endrangeIR0-800-85Firm c pain @ endrange MMT> All major muscles of (B) UE are graded 5/5 except: shoulder flexor 4/5 shoulder abductor 4/5 shoulder extensor 4/5 Sig: Weakness maybe d/t pain. Special tests> (+) Yergasons test on (+) Speeds test on (both could be a false positive result since there is already pain on the shoulder) (-) Neer impingement test on FA> Pt is indep in all aspects of ADLs, bed mob & transfers Able to reach overhead but c pain Able to don & doff shirt c mod difficulty

A> PT Dx: MD Dx of (primary or secondary)adhesive capsulitis (what stage) on shoulder further defined by inability to do overhead activities normally 2 to pain & LOM on shoulderProblem list:1. Pain on what area & structure2. LOM on what structure and laterality, motion3. Functional limitation (difficulty in doing overhead activities on what structure and laterality)

LTG> Rehabilitative: Pt will be able to reach overhead, move shoulder towards all planess pain& play basketball c ease p 6 PT sessions>Preventive: Pt will adhere to HEP& apply pt education p 1 PT session to avoid further complications STG> 1. Pt will report pain (on R shoulder) from 7/10 to 3/10 p 3 PT sessions to help him do his work better2. Pt will demonstrate AROM by ~10 on all movements of shoulder p 3 PT sessions to aid in his work especially in doing overhead as to putting cables & wires.P> Pt will be seen & treated as an OP for 6 PT sessions c ff mx: shoulder1. Continuous or Pulsed US x 1MHz x 1.5 w/cm x 5 on bicipital groove to pain2. HMP x 20 on shoulder to pain3. TENS x 20 on shoulder to pain4. Joint mobilization grade 2 of shoulder towards ant, post, inf gliding x 30secs oscillation x 2 reps to ROM (grade 2 Joint Mob doesnt increase ROM )5. Arm pull of shoulder x 1 rep to relax muscles & joints6. GPS towards shoulder abd, flex &ext x 15secs x 3 sets each to ROM7. Overhead pulley towards shoulder flex &abd of shoulder x 10reps x 2 sets to ROM8. Shoulder wheel towards shoulder ER & IR x 10reps x 2 sets to ROM9. Finger ladder towards shoulder abd& flex c 6SH x 10 reps x 2 sets to ROM

(L) knee (include it in the problem list if there is Rx.)1. HMP x 20 on shoulder & (L) knee to pain2. Hamstring sets x 10 reps x 2 sets c 6SH o strengthen hamstrings (muscle setting doesnt increase strength)3. Short arc quads x 10 reps x 2 sets c 6SH to strengthen quadriceps4. SLR c ext rot x 6SH x 10 reps x 2 sets to strengthen quadricepsHEP>1. Wand exercises2. Self-stretching3. CodmanPt education>1. Respect fatigue2. Stretch properly prior to game & training