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Supraspinatus TendinitisRAHILA NAJIHAH ALIDPH/0102/1130th MAY 2013
Skeletal Structure
 Humans have a strong andwell developed clavicle thatacts as a lateral strut(support) to the scapula andthe humerus. Thi...
Scapulo-Humeral rhythm describes the timing of movement at thesejoints during shoulder elevation1st 30° of shoulder eleva...
Ligament & Capsule
Muscles
Supraspinatus Muscle Origin - supraspinous fossa of scapula Insertion - greater tubercle of humerus Action – Assists de...
Supraspinatus Tendon Most frequently irritated tendon of mostsuperior tendons of glenohumeral joint Vulnerability of thi...
Supraspinatus Tendinitis Inflammation ofsupraspinatus tendon Most common affectedstructure in rotator cuffmuscle that le...
Impingement Occur beneath coraco-acromialarch Most vulnerable structuresbetween undersurface ofacromion and head of hume...
Painful Arc Syndrome painful arc occur on resistedabduction between 60 and120 degrees when theinflamed tendon pressesagai...
Causes Repeated use of arm overhead inoccupation, functional or sports stresses Arm kept at the side or moved withhorizo...
Signs Active movement produce painful arcwith coronal abduction Patient complain of pain discomfortwhen therapist do pas...
Symptoms Pain or limited of ROM Pain at rest with highly reactivecondition Example- lying on side of dysfunction- sit i...
Radiograph X-ray MRI
Treatment Transverse friction massage to thesupraspinatus tendon Use modalities to reduce inflammation likeultrasound, i...
Transverse Friction MassagePosition of patient : sitting with hand ofinjured shoulder placed behind the backand relax the ...
Strengthening weak muscle Muscle that need to be strengthen:-external and internal rotators-deltoid-scapular stabilizers(...
• D1 Flexion pattern: shoulder flexion, elbow flexion, forearmsupination, wrist flexion, and finger flexion.• D1 Extension...
Increase ROM pendulum exercises active assisted ROM exercises active exercises in all planes self-stretches concentrat...
Manipulate tight capsule Joint mobilization of the shoulder joint inferior, anterior, and posterior glides ofshoulderhtt...
CASE STUDYSOAPIER
SubjectiveNAME : Madam YAGE : 63 years oldGENDER : FemaleOCCUPATION : HousewifeDOMMINANT HAND: Left handDATE OF ASSESSMENT...
PRESENT HISTORY : Patient had fall down about 4 weeks agodue to wet floor at a bank. She fall with outstretched lefthand. ...
SPECIAL QUESTIONGeneral health : High blood pressure and depressionPMHx/Surgery : ankle sprain on 2006 and low back pain s...
Pain assessmentSite : Anterior and posterior shoulder near to glenohumeral jointPain scale :4/10 when rest6/10 when lift u...
Body Chartxx X
Objective On observation- Body built : Medium- Deformities : NIL- Swelling : mild swelling around the left shoulder- Post...
 On examination (Range of motion )1) Shoulder*( )-degree where patient start feel painpatient feel pain when do the flexi...
2) ElbowThe ROM of right and left elbow joint is FROMThere’s no complain of pain when do all the movementACTIVE PASSIVE A...
 3) WristThe ROM of wrist joint is FROMthere’s no complain of pain when do all themovementsACTIVE PASSIVE ACTION ACTIVE P...
 Muscle girth*Differences of the muscle girth are 0.5 cm. There’s no musclewastingMUSCLE MEASUREMENT (RIGHT) MEASUREMENT ...
 Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres M...
 Special TestTEST RESULTNeer Impingement Test NegativeHawkins-kennedy Impingement Test NegativeEmpty Can Test Positive
Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoul...
Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- Patient education
Intervention1) Pain releif Interferential therapysite : around the left shoulderposition of patient : sitting with should...
2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil ...
Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient...
4) Patient education Put ice on swelling part of the shoulder Avoid heavy lifting Rest the affected shoulder Don’t lea...
Evaluation Patient fell better after do thetreatments Patient able to lift up the hand over thehead with less pain after...
First follow up
Date of assessment : 27th may 2013Complain : patient is complain of pain increase due to lift the wheel chairinto the carP...
 On examination (Range of motion )1) Shoulderright left*( )-degree where patient start feel painpatient feel pain when do...
 2) elbow-the movements are FROM-there’s no complain of pain when do themovements 3) wrist-the movements are FROM-there’...
 Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres M...
Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoul...
Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- Patient education
Intervention1) Pain relief Interferential therapysite : around the left shoulderposition of patient : sittingprocedure: a...
2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil ...
Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient...
4) Patient education Avoid heavy lifting Rest the affected shoulder Don’t lean on affected side duringsleeping Avoid s...
Evaluation Patient fell better after do the treatment Patient able to lift up the hand over thehead with less pain after...
Second follow up
Date of assessment : 29th may 2013complain : patient fell pain decreasePain scale :3/10 when rest5/10 when lift up the han...
 On examination (Range of motion )1) Shoulderright left*( )-degree where patient start feel painpatient feel pain when do...
 2) elbow-the movements are FROM-there’s no complain of pain when do themovements 3) wrist-the movements are FROM-there’...
 Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres M...
Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoul...
Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- KIV shoulder exercise- Patient education
Intervention1) Pain relief Interferential therapysite : around the left shoulderposition of patient : sittingprocedure: a...
2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil ...
Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient...
4) Patient education Avoid heavy lifting Rest the affected shoulder Don’t lean on affected side duringsleeping Avoid s...
Evaluation Patient fell better after do the treatment Patient able to lift up the hand over thehead with less pain after...
Reference Laura K.Smith, 1995, Brunnstrom’s Clinical Kinesiology, 5thEdition, Book Promotion & Service LTD Joseph E. Mus...
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Supraspinatus tendinitis 30may2013

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Supraspinatus tendinitis 30may2013

  1. 1. Supraspinatus TendinitisRAHILA NAJIHAH ALIDPH/0102/1130th MAY 2013
  2. 2. Skeletal Structure
  3. 3.  Humans have a strong andwell developed clavicle thatacts as a lateral strut(support) to the scapula andthe humerus. This increase glenohumeralmobility to permit reaching& climbing activitiesLaura K.Smith, 1995, Brunnstrom’s Clinical Kinesiology, 5thEdition, Book Promotion & Service LTD
  4. 4. Scapulo-Humeral rhythm describes the timing of movement at thesejoints during shoulder elevation1st 30° of shoulder elevation :glenohumeral jt. : largescapulothoracic jt. : small & inconsistentafter 1st 30° of shoulder elevation :glenohumeral jt. & scapulothoracic jt. movesimultaneouslyratio : 2 : 1 Function :1) preserves the length-tension relationships ofthe glenohumeral muscles2) Prevent impingementLaura K.Smith, 1995, Brunnstrom’s Clinical Kinesiology, 5th Edition, BookPromotion & Service LTDhttp://moon.ouhsc.edu/dthompso/namics/scapryme.htm
  5. 5. Ligament & Capsule
  6. 6. Muscles
  7. 7. Supraspinatus Muscle Origin - supraspinous fossa of scapula Insertion - greater tubercle of humerus Action – Assists deltoid muscle inabducting arm at shoulder jointJoseph E. Muscolino, . The Muscle and Palpation Manual with TriggerPoints, Refferal Patterns, and Stretching
  8. 8. Supraspinatus Tendon Most frequently irritated tendon of mostsuperior tendons of glenohumeral joint Vulnerability of this tendon toinflammation is due to its anatomicallocation
  9. 9. Supraspinatus Tendinitis Inflammation ofsupraspinatus tendon Most common affectedstructure in rotator cuffmuscle that lead todevelopment of pain dueto impingement inshoulder
  10. 10. Impingement Occur beneath coraco-acromialarch Most vulnerable structuresbetween undersurface ofacromion and head of humerusare greater tuberosity, theoverlying supraspinatus tendonand long head of biceps Major site of compression is slightlyanterior to angle of acromion Proper term is painful arcsyndromeJohn Ebnezar,2011, Essential of Orthopaedics for Physiotherapy, 2ndedition,India, Jaypee Brother
  11. 11. Painful Arc Syndrome painful arc occur on resistedabduction between 60 and120 degrees when theinflamed tendon pressesagainst the acromium outside of thisrange, abduction is painlessPatricia A.Downie,1983, Cash’s textbook of Orthopaedics andrheumatology for physiotherapists, London, JP
  12. 12. Causes Repeated use of arm overhead inoccupation, functional or sports stresses Arm kept at the side or moved withhorizontally adducted position Over stress to tendon due to muscleweakness, tight muscle, tight capsule, orbony impingement Poor posture like kyphosis and shouldercomplex protraction Poor body mechanicOtto D.Payton, 1989, Manual of Physical Therapy, NewYork, Edinburgh, London, Churchill Livingstone
  13. 13. Signs Active movement produce painful arcwith coronal abduction Patient complain of pain discomfortwhen therapist do passive stretching ofsupraspinatus tendon Patient complain of pain when therapistdo resisted isometric contracture ofexternal rotation and both diagonal andcoronal abductionOtto D.Payton, 1989, Manual of Physical Therapy, NewYork, Edinburgh, London, Churchill Livingstone
  14. 14. Symptoms Pain or limited of ROM Pain at rest with highly reactivecondition Example- lying on side of dysfunction- sit in chair with too high arm rest Limitation of function with elevateddiagonal movementOtto D.Payton, 1989, Manual of Physical Therapy, NewYork, Edinburgh, London, Churchill Livingstone
  15. 15. Radiograph X-ray MRI
  16. 16. Treatment Transverse friction massage to thesupraspinatus tendon Use modalities to reduce inflammation likeultrasound, iontophoresis, phonophoresis, IFT andhigh voltage stimulation Educate in posture and body mechanics Stretch tight muscle Strengthen weak muscle Manipulate thigh capsuleOtto D.Payton, 1989, Manual of Physical Therapy, NewYork, Edinburgh, London, Churchill Livingstone
  17. 17. Transverse Friction MassagePosition of patient : sitting with hand ofinjured shoulder placed behind the backand relax the armPosition of therapist: Stand in behind ofthe client’s shoulder to find thesupraspinatus tendonProcedure : videoVal Robertson, 2009, Electrotherapy Explainedprinciples and practise, 4th edition, China, Elsevier
  18. 18. Strengthening weak muscle Muscle that need to be strengthen:-external and internal rotators-deltoid-scapular stabilizers(rhomboids, trapezius, serratusanterior, latissimus dorsi) Do the proprioceptive neuromuscularfacilitation (PNF)http://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis
  19. 19. • D1 Flexion pattern: shoulder flexion, elbow flexion, forearmsupination, wrist flexion, and finger flexion.• D1 Extension pattern: shoulder extension, elbow extension, forearmpronation, wrist and finger extension.• D2 Flexion pattern: shoulder flexion, elbow extension, forearmsupination, wrist extension, and finger extension.• D2 Extension pattern: shoulder extension, elbow flexion, forearmpronation, wrist and finger flexionhttp://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis
  20. 20. Increase ROM pendulum exercises active assisted ROM exercises active exercises in all planes self-stretches concentrating mainly onposterior joint capsulehttp://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis
  21. 21. Manipulate tight capsule Joint mobilization of the shoulder joint inferior, anterior, and posterior glides ofshoulderhttp://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis
  22. 22. CASE STUDYSOAPIER
  23. 23. SubjectiveNAME : Madam YAGE : 63 years oldGENDER : FemaleOCCUPATION : HousewifeDOMMINANT HAND: Left handDATE OF ASSESSMENT : 22nd Mei 2013CHIEF COMPLAINT : Patient complaint pain at her leftshoulder when lifting up the left hand above the headlevel and try to lift heavy things. Patient also complaindifficulty in dressing especially when trying to wear braand take out her cloth.
  24. 24. PRESENT HISTORY : Patient had fall down about 4 weeks agodue to wet floor at a bank. She fall with outstretched lefthand. She only felt pain after 3 days prior to the injury. Shewent to traditional Chinese doctor and did massage but thepain became worse.PAST HISTORY : NILSOCIAL HISTORY : She stays with her husband and daughterat a terrace house in Kuala Lumpur. She takes care of herhusband that has Alzheimers disease since 12 years and alsodoes a lot of housework. Sometimes she takes her husbandfor morning walk around her housing area. Patient is a non-smoker and doesn’t consume alcohol.
  25. 25. SPECIAL QUESTIONGeneral health : High blood pressure and depressionPMHx/Surgery : ankle sprain on 2006 and low back pain since2008Lx/X-Ray/MRI :i) X-Ray for ankle on 2006ii) MRI for whole body on 2008MEDICATION/STEROID : under medicationi) Patenolol 100mg 1 tablet, 2 times per day for high bloodpressureii) Patient taking another type of high blood pressuremedicine but does not remember it’s nameiii) Lexapio 5mg 2 tablet per day for depression
  26. 26. Pain assessmentSite : Anterior and posterior shoulder near to glenohumeral jointPain scale :4/10 when rest6/10 when lift up the hand above head level and carry heavythingsNature of pain : Pulling painAggravating factor : Lift up the hand above head level and carryheavy thingsEasing factor : Resting hand on the abdomen in internal positionof shoulderIrritability : Medium24 hours :am : No painpm : sometime disturb sleepOnset : Gradual
  27. 27. Body Chartxx X
  28. 28. Objective On observation- Body built : Medium- Deformities : NIL- Swelling : mild swelling around the left shoulder- Posture : Slightly kyphotic On palpation- Spasm : on the anterior and posterior part of leftshoulder- Warmth : no- Tightness : on anterior part of left shoulder
  29. 29.  On examination (Range of motion )1) Shoulder*( )-degree where patient start feel painpatient feel pain when do the flexion, extension, abduction and medialrotation of left shoulderall action of right shoulder is FROMACTIVE PASSIVE ACTION ACTIVE PASSIVE0-180° 0-180° Flexion 0-160° (150°) 0-170°0-60° 0-60° Extension 0-50° (30°) 0-60°0-180° 0-180° Abduction 0-165° (70-120°)0-170°Adduction0-80° 0-80° MedialRotation0-70° (60°) 0-80°0-90° 0-90° LateralRotation0-90° 0-90°Right Left
  30. 30. 2) ElbowThe ROM of right and left elbow joint is FROMThere’s no complain of pain when do all the movementACTIVE PASSIVE ACTION ACTIVE PASSIVE0-140° 0-140° Flexion 0-140° 0-140°140-0° 140-0° Extension 140-0° 140-0°0-80° 0-80° Pronation 0-80° 0-80°0-80° 0-80° Supination 0-80° 0-80°Right Left
  31. 31.  3) WristThe ROM of wrist joint is FROMthere’s no complain of pain when do all themovementsACTIVE PASSIVE ACTION ACTIVE PASSIVE0-70° 0-70° Flexion 0-70° 0-70°0-60° 0-60° Extension 0-60° 0-60°0-20° 0-20° Ulnar dev. 0-20° 0-20°0-30° 0-30° Radial dev. 0-30° 0-30°Right Left
  32. 32.  Muscle girth*Differences of the muscle girth are 0.5 cm. There’s no musclewastingMUSCLE MEASUREMENT (RIGHT) MEASUREMENT (LEFT)DELTOID 31.5 CM 31.0 CMBICEPS 30.5 CM 30.0 CMTRICEPS 29.5 CM 29.0 CMBRACHIALRADIALIS 23.0 CM 22.5 CM
  33. 33.  Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres Major,Posterior DeltoidEXTENSION 4/5 3/5Middle Deltoid &SupraspinatusABDUCTION 4/5 3/5Pectoralis Major ADDUCTION 4/5 3/5Subscapularis MEDIALROTATION4/5 3/5Infraspinatus &Teres MajorLATERALROTATION4/5 3/5
  34. 34.  Special TestTEST RESULTNeer Impingement Test NegativeHawkins-kennedy Impingement Test NegativeEmpty Can Test Positive
  35. 35. Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoulder due to pain-reduce muscle power in left hand due to weakness-left Supraspinatus tendinitis GoalsShort Term Goal- To reduce pain at the left shoulder- To increase range of motion of flexion, extension, abduction and medialrotation of left shoulder- Improve the muscle power of left shoulderLong Term Goal- To improve functional activity of daily life ( patient can take care of herhusband and able to do housework with no pain )
  36. 36. Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- Patient education
  37. 37. Intervention1) Pain releif Interferential therapysite : around the left shoulderposition of patient : sitting with shoulder in relax positionprocedure : apply 4 pole at left shoulderduration: 10 minutespurpose : relieve pain Ultrasoundsite : anterior site of the left shoulderposition of patient : sits with his arm behind the back in medial rotationduration : 5 minutespurpose : promote healing process Crayo cuffsite : left shoulderposition : sit with the shoulder in relax positionduration :10 minutespurpose : to reduce swelling
  38. 38. 2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil and Ultimax gel around the leftshoulderpurpose : relaxing the muscle Transverse friction massageSite : anterior to acromion processDuration : 5 minutesPosition of patient : patient sits with his arm behind the back inmedial rotationProcedure : index finger of the ipsilateral hand, reinforced by themiddle finger. The thumb should be placed quite far down thearm. So that a downward pressure is exerted on the greatertuberosity, the index finger-nail remaining horizontal.Purpose : to break the adhesion around the joint
  39. 39. Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient’s left hand is extended andadducted behind the bodyrepetition : 10 repetition 3 times daily
  40. 40. 4) Patient education Put ice on swelling part of the shoulder Avoid heavy lifting Rest the affected shoulder Don’t lean on affected side duringsleeping Avoid sudden movement of the affectedshoulder
  41. 41. Evaluation Patient fell better after do thetreatments Patient able to lift up the hand over thehead with less pain after TransverseFriction Massage at the shoulder jointReview Reassess ROM , muscle girth for next visit Review the muscle power
  42. 42. First follow up
  43. 43. Date of assessment : 27th may 2013Complain : patient is complain of pain increase due to lift the wheel chairinto the carPain scale :5/10 when rest7/10 when lift up the hand above head level and carry heavy thingsOn observationSwelling : mild swelling around the left shoulderOn palpation- Warmth : no- Tightness : on anterior part of left shoulder
  44. 44.  On examination (Range of motion )1) Shoulderright left*( )-degree where patient start feel painpatient feel pain when do the flexion, extension, abduction and medial rotationof left shoulderall action of right shoulder is FROMACTIVE PASSIVE ACTION ACTIVE PASSIVE0-180° 0-180° Flexion 0-160° (150°) 0-170°0-60° 0-60° Extension 0-50° (30°) 0-60°0-180° 0-180° Abduction 0-165° (70-120°)0-170°Adduction0-80° 0-80° MedialRotation0-70° (60°) 0-80°0-90° 0-90° LateralRotation0-90° 0-90°
  45. 45.  2) elbow-the movements are FROM-there’s no complain of pain when do themovements 3) wrist-the movements are FROM-there’s no complain of pain when dothe movements 4) Spasm : on the anterior and posteriorpart of left shoulder
  46. 46.  Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres Major,Posterior DeltoidEXTENSION 4/5 3/5Middle Deltoid &SupraspinatusABDUCTION 4/5 3/5Pectoralis Major ADDUCTION 4/5 3/5Subscapularis MEDIALROTATION4/5 3/5Infraspinatus &Teres MajorLATERALROTATION4/5 3/5
  47. 47. Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoulder due to pain-reduce muscle power in left hand due to weakness-patient did not do the stretching that had taught by therapist Goalsshort term goal- To reduce pain of the left shoulder- To increase range of motion the flexion, extension, abduction and medialrotation of left shoulder- Improve the muscle power of the left shoulderLong Term Goal- To improve functional activity of daily life ( patient can take care of herhusband and able to do housework with no pain )
  48. 48. Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- Patient education
  49. 49. Intervention1) Pain relief Interferential therapysite : around the left shoulderposition of patient : sittingprocedure: apply 4 pole at left shoulderduration: 10 minutespurpose : relieve pain Ultrasoundsite : anterior site of the left shoulderposition of patient : sittingduration : 5 minutespurpose : promote healing process Crayo cuffsite : left shoulderposition : 10 minutespurpose : to reduce swelling
  50. 50. 2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil and Ultimax gel around the leftshoulderpurpose : relaxing the muscle Transverse friction massageSite : between glenohumeral jointDuration : 5 minutesPosition of patient : patient sits with his arm behind the back inmedial rotationProcedure : index finger of the ipsilateral hand, reinforced by themiddle finger. The thumb should be placed quite far down thearm. So that a downward pressure is exerted on the greatertuberosity, the index finger-nail remaining horizontal.Purpose : restoring mobility to muscles
  51. 51. Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient’s left hand is extended andadducted behind the bodyrepetition : 10 repetition 3 times daily
  52. 52. 4) Patient education Avoid heavy lifting Rest the affected shoulder Don’t lean on affected side duringsleeping Avoid sudden movement of the affectedshoulder Therapist emphasize the importance ofstretching
  53. 53. Evaluation Patient fell better after do the treatment Patient able to lift up the hand over thehead with less pain after TransverseFriction Massage at the shoulder jointReview Reassess ROM , muscle girth for next visit Review the muscle power
  54. 54. Second follow up
  55. 55. Date of assessment : 29th may 2013complain : patient fell pain decreasePain scale :3/10 when rest5/10 when lift up the hand above head level and carry heavy thingsOn observationSwelling : mild swelling around the left shoulderOn palpation- Spasm : on the anterior and posterior part of left shoulder- Warmth : no- Tightness : on anterior part of left shoulder
  56. 56.  On examination (Range of motion )1) Shoulderright left*( )-degree where patient start feel painpatient feel pain when do the flexion, extension, abduction and medial rotationof left shoulderall action of right shoulder is FROMACTIVE PASSIVE ACTION ACTIVE PASSIVE0-180° 0-180° Flexion 0-160° (150°) 0-170°0-60° 0-60° Extension 0-50° (30°) 0-60°0-180° 0-180° Abduction 0-165° (70°) 0-170°Adduction0-80° 0-80° MedialRotation0-70° (60°) 0-80°0-90° 0-90° LateralRotation0-90° 0-90°
  57. 57.  2) elbow-the movements are FROM-there’s no complain of pain when do themovements 3) wrist-the movements are FROM-there’s no complain of pain when dothe movements
  58. 58.  Muscle Power (Shoulder)MUSCLE ACTION RIGHT LEFTAnterior Deltoid &CoracobranchialisFLEXION 4/5 3/5Latisimus Dorsi,Teres Major,Posterior DeltoidEXTENSION 4/5 3/5Middle Deltoid &SupraspinatusABDUCTION 4/5 3/5Pectoralis Major ADDUCTION 4/5 3/5Subscapularis MEDIALROTATION4/5 3/5Infraspinatus &Teres MajorLATERALROTATION4/5 3/5
  59. 59. Analysis Physiotherapy impression- pain at the anterior and posterior site of left shoulder-reduce full ROM of left shoulder due to pain-reduce muscle power in both hand due to weakness- patient did not do the stretching that already taught by therapist Goalsshort term goal- To reduce pain- To increase range of motion- Improve the muscle powerLong Term Goal- To improve functional activity of daily life
  60. 60. Plan of treatment- Pain relief- Soft tissue manipulation- Home program exercise- KIV shoulder exercise- Patient education
  61. 61. Intervention1) Pain relief Interferential therapysite : around the left shoulderposition of patient : sittingprocedure: apply 4 pole at left shoulderduration: 10 minutespurpose : relieve pain Ultrasoundsite : anterior site of the left shoulderposition of patient : sittingduration : 5 minutespurpose : promote healing process Crayo cuffsite : left shoulderposition : 10 minutespurpose : to reduce swelling
  62. 62. 2) Soft tissue manipulation Superficial soft tissue manipulationsite: around the left shoulderprocedure : apply Repairil and Ultimax gel around the leftshoulderpurpose : relaxing the muscle Transverse friction massageSite : between glenohumeral jointDuration : 5 minutesPosition of patient : patient sits with his arm behind the back inmedial rotationProcedure : index finger of the ipsilateral hand, reinforced by themiddle finger. The thumb should be placed quite far down thearm. So that a downward pressure is exerted on the greatertuberosity, the index finger-nail remaining horizontal.Purpose : restoring mobility to muscles
  63. 63. Contd.3) Home program exerciseStretching the Supraspinatus muscleposition of patient : sitting or standingaction : patient’s left hand is extended andadducted behind the bodyrepetition : 10 repetition 3 times daily
  64. 64. 4) Patient education Avoid heavy lifting Rest the affected shoulder Don’t lean on affected side duringsleeping Avoid sudden movement of the affectedshoulder
  65. 65. Evaluation Patient fell better after do the treatment Patient able to lift up the hand over thehead with less pain after TransverseFriction Massage at the shoulder jointReview Reassess ROM , muscle girth for next visit Review the muscle power
  66. 66. Reference Laura K.Smith, 1995, Brunnstrom’s Clinical Kinesiology, 5thEdition, Book Promotion & Service LTD Joseph E. Muscolino, . The Muscle and Palpation Manualwith Trigger Points, Refferal Patterns, and Stretching John Ebnezar,2011, Essential of Orthopaedics forPhysiotherapy, 2nd edition,India, Jaypee Brother Patricia A.Downie,1983, Cash’s textbook of Orthopaedicsand rheumatology for physiotherapists, London, JP Otto D.Payton, 1989, Manual of Physical Therapy, NewYork, Edinburgh, London, Churchill Livingstone Val Robertson, 2009, Electrotherapy Explained principlesand practise, 4th edition, China, Elsevier http://morphopedics.wikidot.com/physical-therapy-management-of-supraspinatus-tendinitis http://moon.ouhsc.edu/dthompso/namics/scapryme.htm

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