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Learning
Group 2
GROUP M E M B E R S
Names
Aliza Jamshaid 70110977
Laiba Hanif 70113582
Khadija Ramzan 70121146
Aqsa Bibi 70122871
Hafsa Yaseen 70120651
Areej Salamat 70120404
M.Hamza Khan 70122723
Kinza Tariq 70121191
TABLE OF C O N T E N T S
1 2
PATIENT DATA EXAMINATION &
A SSE SSM E N T
This will include demographic
data and history of patient as This section will include patient
well as family history assesment and examination
3 4 5
DIFFERENTIAL
DIAGNOSIS TREATME NT
DIAGNOSIS
This will include our final This section will include possible
DD will include a list of possible
diagnosis based on physical physiotherapy treatments,
conditions that share the same
examination and X-ray findings home plan and prognosis
symptoms
C A S E SCENARIO
AGE: 45
EVALUATION
DATE: 2 2 - 2 - 2 4
MARITAL STATUS:
Married
GENDER: Female
PRESENTING C O M P L A I N
Patient has dull and achy pain in right shoulder and sharp pain on posterior
right shoulder. Intensity of pain was severe. The pain aggravates on
movement when doing daily life activities or at work and lying on it while
sleeping, and is relieved by hot water application. The condition developed
gradually over time of 3-4 months and now condition is so severe that
patient came for first time for physiotherapy.
PAST MEDICAL HISTORY:
None
FAMILY HISTORY:
Hypertension (father)
SOCIOECONOMICSTATUS:
House wife ( Sedentary lifestyle)
Prolonged Standing
OLD CART DETAILS
O ONSET (sudden)
S SEVERITY (moderate)
VITALS
VITALS TAKING
2.
EXAINATION &
ASSESSMENT
Assessment, evaluation and special tests
G EN ER AL EXAM I N AT I O N
J Jaundice:Absent
A Anemia:Absent
C Clubbing:Absent
K Koilonychia:Absent
L Leukonychia:Absent
E Edema:Absent
JACKLE VIDEO
GENERALSYSTEMIC REVIEWS
Cardiovascular Nill
Musculoskeletal Limited ROM , Stiffness
Pulmonary Nill
Neuromuscular Nill
Integumentary Nill
Psychosocial Nill
P H Y S I C A L EXAM I N AT I O N
LOOK
Normal
FEEL
Supraspinatous(spasm)
Subscapularis(spasm) MOVEMENT
Teres minor(spasm)
Infraspinatous(spasm) Restrited AROM
Deltoid (spasm) PROM with pain
Stiffness
3.
DIFFERENTIAL
DIAGNOSIS
List of possible conditions that share the same symptoms
Shoulder Rotator cuff Frozen
Impingement Tear Shoulder
Shoulder
Pain
Shoulder Impingement
Shoulder impingement is a condition where the tendons and bursa in your
shoulder get pinched or compressed. This can cause pain and limited range of
motion in your shoulder. It's often caused by repetitive overhead movements or
poor posture.
Symptoms:
1. Pain or tenderness in the shoulder especially when lifting or reaching
overhead.
2. Weakness or difficulty moving your arm, as well as a clicking or popping
sensation in the shoulder joint.
Rotator cuff Tear
A rotator cuff tear is a common injury that affects the muscles and tendons in the shoulder
joint. It occurs when one or more of the tendons that make up the rotator cuff become torn.
This can happen due to acute trauma, such as a fall or lifting a heavy object, or from
degenerative changes over time.
Symptoms:
1. shoulder pain
2. Weakness
3. Limited range of motion
Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition
characterized by stiffness and pain in the shoulder joint. It typically develops
gradually and can limit the range of motion in the shoulder. It can be
associated with factors such as injury, diabetes, or prolonged immobilization.
Symptoms:
1. Shoulder stiffness
2. Pain
3. Significant loss of passive range of motion
4. Pain while sleeping at any position
5. Pain at doing over head activities
6. Limited external rotation and abduction
Special Test
Neer Impingement Test (Shoulder):
Purpose:
Detects subacromial impingement, which is the
compression of tendons within the shoulder.
Procedure:
The examiner raises the patient's arm overhead
while internally rotating it.
Positive Test:
Pain in the shoulder during the movement.
Drop Arm Test:
Purpose:
The drop arm test is used to assess for full
thickness rotator cuff tears, particularly of
the supraspinatus.
Procedure:
Stand behind the seated patient and
passively abduct the patient's arm to 900 and full
external rotation, while supporting the arm at the
elbowRelease the elbow support and ask patient to
slowly lower the arm back to neutral.
Empty Can Test:
Purpose:
The Empty Can Test is used to assess
for lesions of the supraspinatus muscle and
supraspinatus tendon.
Procedure:
In this test, the patient is tested at 90°
elevation in the scapular plane and full internal
rotation (empty can). The patient resists
downward pressure exerted by the examiner at
the patient's elbow or wrist.
Apley’s scratch test:
Purpose:
Quick method to assess all the
movements of shoulder joint. Provocative in
diagnosing frozen shoulder.
Procedure:
The patient attempts to touch the opposite
scapula to test range of motion of shoulder.
Positive test:
Pain to touch opposite shoulder.
Head to Neck:
Investigation
X-ray
MRI
X ray of shoulder joint
Normal Shoulder Joint:
An X-ray of a normal shoulder joint typically shows:
Smooth bone surfaces of the humerus, scapula, and clavicle
Clear joint space between the humerus and scapula,
which is typically 3-6 mm wide No signs of bone abnormalities,
such as fractures, arthritis, or tumors
X ray of frozen shoulder joint:
X-rays are not always diagnostic for frozen
shoulder, as they may appear normal in some
cases. However, they can sometimes show:
Slight decrease in joint space, which may be
narrower than the usual 3-6 mm Osteopenia (bone
loss) due to disuse of the shoulder joint
No significant bone abnormalities, such as
fractures
MRI of normal shoulder joint
An MRI scan of a healthy shoulder joint typically reveals:
Bones:The humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone)
appear with distinct, smooth bone surfaces.
Ligaments and tendons:These appear as well-defined bands or sheets with uniform signal
intensity.
Muscles:The shoulder muscles, including the rotator cuff muscles, appear with normal size
and signal intensity.
Joint capsule and bursa: The joint capsule appear normal without any swelling or
inflammation.
Joint space: The space between the humeral head
and the glenoid cavity appears clear and maintains
a normal width, typically between 3-6 mm.
MRI of frozen shoulder
Thickened capsule
Fluid buildup
Inflammation
Rotator cuff damage
4.
DIAGNOSIS
Final diagnosis
FINAL DIAGNOSIS
TRE ATME N T
Physiotherapy treatment, home plan and diagnosis
Short Term Goals
Modalities
Acute stage:
Cold Pack
(15-20 min)
MODALITE S
Chronic stage:
H O T PACK
(10-15 minutes)
TENS
(10- 25 minutes)
MODALITES
Massage Gun
(10-30 seconds)
Therapeutic ultrasound
(5 minutes)
Plan of care
Glides given to relieve Adhesive Capsuliltus
1. Wand exercise
2. Pulley exercise
3. Lastimus Dorsi stretch
4. Supraspinatus stretch
Isometrics will also be prescribed for home palm to enhance stability of muscle