This document describes a 49-year-old unemployed man who presented with a 4-month history of deep left shoulder pain that was aggravated by lifting and sudden movements. Examination revealed reduced range of motion and muscle strength in the left shoulder compared to the right, along with tenderness over the supraspinatus tendon. He was diagnosed with adhesive capsulitis and supraspinatus tendinitis. Treatment included ultrasound, ice, range of motion exercises, and strengthening exercises. After 4 days of treatment, his pain level and range of motion had improved in the left shoulder.

1. UCP /AL/11/202

2.  Name : X
 Age : 49 years
 Gender : Male
 Occupation : Unemployed . Earlier technical
supervisor in Dubai .
 Civil Status : Married
 Family details : Has 3 children

3.  Deep aching pain in left shoulder since 4
months.
 It’s gradually onset pain.
 Pain location:Pain over the acromion process
to deltoid insertion area.
 Pain is worst at night
 Pain is aggravated by lifting weights and
sudden movements of shoulder.

4.  Due to pain and stiffness cannot engage the
ADL such as combing hair
weight lifting
unable to reach high shelves
 Specially he’s unable to go to his job due to
his painful shoulder.
 Past medical history : DM + , HT +
 Past surgical history: None

5. Observation
 Observed from anteriorly , posteriorly &
laterally in sitting and standing position.
 Colour and texture of the skin is normal and
no scars.
 No swelling around shoulder region.
 Left shoulder is higher than right shoulder.
 No muscle atrophy.

6. Palpation
 Tenderness over supraspinatus tendon & deltoid
muscle.
 No tenderness over cervical region.
 No muscle spasms.
 No muscle tighgtness.
 No altered temperature around shoulder.

7. Tests
A-ROM Right Left
 Shoulder flexion 160 140
 Shoulder extension 55 35
 Shoulder abduction 175 60
 med: rotation 60 25
 Lat: rotation 80 45
 Neck & elbow movements are normal . No any
pain

8. MUSCLE STRENGTH OF SHOULDER REGION
Right Left
 Shoulder extensors 5 4
 Shoulder abductors 5 3
 Shoulder flexors 5 3
 Shoulder adductors 5 4
TESTS
 Speed test – Negative
 Yergoson test-Negative
 Empty can test – positive
 Supraspinatus tendinitis test – positive
 Pain according to VAS - 8

9. Adhesive capsulitis
Supraspinatus tendinitis
 Shoulder movements are restricted due to
pain and stiffness.( due to adhesive
capsulitis and supraspinatus tendinitis)

10. Short term goals
 Relief pain
 Reduce inflammation
 Increase ROM
 Increase muscle strength
 Maintain soft tissue and joint integrity mobility
 Prevent adhesions
 Advice and reassure the patient
 Reeducation of functional movements
Long term goals
 Restore shoulder movement in order to do
activities of daily living (ADL)

11.  IR therapy -15 mins-trice a week
Reduce pain and relax the muscles.
 Ice therapy- 10 to 20 mins-before bed
Reduce night pain.
 Ultrasound therapy – 1MHz , 4mins,0.8
W/CM-2- Over supraspinatus tendon
Facilitating removal exudates and reduce
inflammation.
 Pendulum exercises To relieve pain
through gentle traction and oscillating
movements , Relax the muscles , Mobilize
the shoulder

12. 
 Passive ROM exercises- in all ranges of pain
free motion Maintain soft tissue and
joint integrity mobility


13.  Accessory movements
- grade I & II oscillatory movements – pain
relief
-grade III & IV oscillatory movements –
increase ROM
-longituidanal, anteroposterior,
posteroanterior directions
 Soft tissue manipulation
-Friction-tranverse friction applied to
supraspinatus tendon-to mobilize the tendon,
adhesions are softened and streched
 Active assisted and active movements-
increase ROM , increase joint mobility- 10
repetitions twice a day

15.  Strengthening exercises –with and without
weight
Shoulder girdle, neck & elbow
mobilization exercises
Advices-don’t sleep on affected
side

16.  Pain- limit movements , decrease the quality of
life- therefore used IR therapy ,ice therapy ,
manipulation techniques
 Increase ROM- all the movements are limited,
unable to do day to day life activities –
therefore used accessory movements ,ROM
exercises , mobilization exercises
 Muscle strengthening –stiff and painful joints
movement limitation muscle
wasting- have to do strengthening exercises
 Re educate the muscle function-he used to
perform ADL by unaffected hand , so have to
re-educate activities

17. AFTER 4 DAYS RANGES IN DEGREES
A-ROM Right Left Before
 Shoulder flexion 160 150 140
 Shoulder extension 55 40 35
 Shoulder abduction 175 80 60
 med: rotation 60 30 25
 Lat: rotation 80 52 45
 Pain according to VAS-5
 Muscle strengthening of left shoulder
Before After
 Shoulder extensors 4 4
 Shoulder abductors 3 4
 Shoulder flexors 3 4
 Shoulder adductors 4 4

18. THANK YOU