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3 4 5
EXAMINATION &
ASSESSMENT
DIFFERENTIAL
DIAGNOSIS
DIAGNOSIS TREATMENT
PATIENT DATA
This will include demographic
data and history of patient as
well as family history
This section will include patient
assesment and examination
DD will include a list of possible
conditions that share the same
symptoms
This will include our final
diagnosis based on physical
examination and X-ray findings
This section will include possible
physiotherapy treatments,
home plan and prognosis
TABLE OF CONTENTS
5.
6. CASE SCENARIO
A 45 years old patient named as Shafia Bibi
came to Hospital with severe restriction of
movement on one side of shoulder from 3
months. Pain at the deltoid insertion. Pain with
shoulder movement. Nagging pain at night, with
sleep deprivation and the inability to sleep on
the affected side.
8. DEMOGRAPHIC DATA
NAME: Shafia Bibi
AGE: 45
GENDER: Female
MARITAL STATUS:
Married
ADDRESS: Raiwind,
Lahore
OCCUPATION:
House wife
EVALUATION
DATE: 22-2-24
9.
10. PRESENTING COMPLAIN
Right shoulder pain ( 3 months)
Tenderness
Stiffness
Restricted ROM
Unable to perform ADLs
11. HISTORY OF PRESENTING COMPLAINT
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.
12.
13. PAST MEDICAL HISTORY:
None
FAMILY HISTORY:
Hypertension (father)
SOCIOECONOMICSTATUS:
House wife ( Sedentary lifestyle)
Prolonged Standing
14. OLD CART DETAILS
O ONSET (sudden)
L LOCATION (lumber region)
D DURATION (on and off)
C CHARACTERISTICS (localized and sharp)
A AGGREVATING FACTORS (activity)
R RELIEVING FACTORS (rest)
T TEMPORAL PATTERN (constant pain)
S SEVERITY (moderate)
26. 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.
27. 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
28. 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
29. 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.
30. 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.
31. 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.
32. 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.
35. 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
36. 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.
39. FINAL DIAGNOSIS
With the help of clinical examination and review of symptoms we
can conclude that the patient is suffering from frozen shoulder and it
is confirmed by X-ray and MRI findings.
40. 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.
Stages of frozen Shoulder:
41. Frozen shoulder patient have shoulder pain, stiffness and limited ROM:
1. Active and passive range motions
2. Particularly external rotation( 33/60 degree) and abduction movements
(98/180 degree)
Patient can’t do overhead activities and pain in night.
42. Prognosis
The patients prognosis will be fair as she is 45 years old and
physically weak so it will take time for her to recover.
47. Plan of care
Glides given to relieve Adhesive Capsuliltus
Glides will facilitate greater mobility and reduce pain.
1. Glenohumeral inferior glide. (For shoulder abduction)
2. Glenohumeral posterior glide (For flexion and internal rotation)
3. Glenohumeral Anterior glide. (For external rotation)
48.
49. 1. Pendulum Stretch (relaxes shoulder)
2. Wand/Towel exercise (Improve external rotation)
3. Finger/Ladder Exercise (Improve flexion and abduction)
4. Cross body stretch (Improves Adduction)
5. Pulley exercise (Improves flexion /extension)
Stretching Exercises
Stretching can help improve flexibility and strength
as a result, the range of motion of the joint
improves.
10 repitions each, otherwise depending upon
patient condition.
50.
51. Home Plan
1. Wand exercise
2. Pulley exercise
3. Lastimus Dorsi stretch
4. Supraspinatus stretch
52. Isometrics will also be prescribed for home palm to enhance stability of muscle
5 to 10 sec contract and then relax for 5 sec, 7 to 10 rep each
1. Isometrics for flexion
2. Isometrics for internal rotation.
3. Isometrics for external rotation
4. Isometrics for extension.
