CASE STUDY

Demographic Details :

 Name - Mrs. Kamla Arora

 Occupation – Retired Teacher
 Date of Examination – 16 september 2018
 Age – 71 years
 Gender - Female
 Hand dominace – right hand dominant
 Address – Sector- 15A, Faridabad
 Contact No. – 9829******
 Chief Complaint:
Patients complaint of pain in left shoulder since 3
months.

 History of Present Illness:

Patient was apparently alright before 3 months. Patient
experienced pain in left shoulder which is gradual onset
but since 1 month she experienced more pain in night
and unable to sleep on the affected side. She’s unable to
do overhead activities & ADLs. Patient came to Metro
Hospital for the Physiotherapy.
 Past History: Not Relevant

 Medical History: no H/o DM

HTN
 Surgical History: H/o B/L Knee Replacement (2009)

 Family History: Not Relevant

 Personal History: Sleep – Disturbed

Smoking- Non smoker
Pain History :

 Type of Pain: Dull Aching Pain

 Site of Pain: Anterior aspects of shoulder

 Side of Pain: Left Shoulder

 Nature / Behavior of pain: Continue

 Onset of Pain: Gradual

 Duration of Pain: 3 months

 NPRS (Numeric Pain Rating scale) : 3 at rest

7 at activity

 Aggravating Factors: on shoulder movement

over head activities

 Relieving Factors: Rest

Hot Fermentation
Observation:

 Built – Endomorphic

 Gait - Normal but decreased arm swing during gait

 Posture – Stoop Posture ( forward head & rounded

shoulder )

 Obvious deformity- genu varum

 Swelling – Mild swelling present around the shoulder

Examination:

 Tenderness – Present grade 2 (at bicipital groove)

 ROM – Left shoulder

Movement ROM
Flexion O-90°
Extension 90°-0
Abduction 0-100°
Internal rotation 0-25°
External rotation 0-20°
 MMT – Upper Limb (pain free ROM)

MMT Grading
Flexor 3+/5
Extensor 3+/5
Abductor 4/5
Adductor 4/5
Internal rotators 3+/5
External rotators 3+/5
 Resisted Isometrics Contraction (RIC) :
Painful & Weak
 Differential Diagnosis – Shoulder Impingement
Rotator cuff injury
Osteoarthritis (OA)
Bursitis

 Special Test –
 Shoulder shrug sign - +ve

How to perform ?
High sitting patient position, instruct the patient to flex both elbows
to 90° and then, abduct the shoulder to 90° and hold for 2sec.

Capsular Pattern - +ve

Limitation of external rotation >abduction >internal rotation

 Diagnosis - Peri Arthritis Shoulder (left)

 Treatment :

Short term goal-

 Pain relief
 Decrease swelling
 To gain ROM
 Gradual strengthening

Long term goal –

 To gain full ROM
 To strengthen the muscle
 Return to ADL’s
Pain relief & decrease swelling
 MHP (15 mins.)
 TENS (15 mins.)
 US at tender point (05 mins x 0.9 W/cm2)

To restore joint mobility

 Passive ROM ex’s (flexion,

abduction & external rotations)

 Scapulo-humeral rhythm/ Scapula mobilization
 Shoulder Glides-
 AP glide (flexion) Caudal glide (abduction)

 PA glide (extension)
 Stretching ex’s

 Cross body reach / capsular stretch

 Towel stretch
 Pectoralis stretch
 To strengthening muscles
 Isometrics

 Resistance training
 A. theraband ex’s
 B. weight training
Exercises
Wall pulley
Finger walk Shoulder wheel
 Pendulum ex’s
Precaution –
• Avoid heavy weight lifting
• Avoid over head activities

Home exercises -
• Hot fermentation
• Assisted flexion
• AROM
• Self strengthening
• Wall ladder
• Pendulum exercises
• Towel exercise
Prognosis-
• After a month ROM as follow:
oFlexion- 0-180°
oAbduction – 0-180°
oExternal rotation- 0-70°
oInternal rotation – 0-65°