Case presentation

Case presentation nuwanthika

1. K.A.N.K.K.Arachchi Ucp /al/11/206 Case presentation

2. Subjective examination personal information Name: X Age : 57years old Gender: female Occupation: retired clerk Position in the Family :mother of one son

3. History of present complains No history of trauma Pain in upper shoulder level gradually spreads down to elbow and to the neck Type of pain :Aching deep dull pain Location : over left shoulder Onset : Gradual onset for 6 months

4. Present complaints End ROM pain 24- hour behavior of symptoms-Pain disturbs sleep Aggravating factors hand behind back above head activities lifting weight Easing factors Supporting the weight of the arm Past medical history: suffering from diabetes & following medications

5. Objective examination Observation Informal observation she looks like a healthy woman but sad in mood due to her shoulder problem. Formal observation observe from Anteriorly, Posteriorly, Laterally in both sitting & standing positions. -a shoulder hike is seen in right shoulder - - rounded shoulders -poking chin -No changes in muscle contours no abnormal skin discoloration -no scar

6. palpation Tenderness over left acromioclavicular area Tight upper fibers of trapezius No local skin temperature difference

7. Tests All AROMs & PROMs of left shoulder joint are limited. According to VAS pain scale pain = 6

8. Tests Muscle power (Oxford medical research center scale) Muscle group grade flexors 4 extensors 3 Abductors 3 adductors 4 External rotators 3 Internal rotators 3 Functional assessment eating combing hair put something on shelf brushing teeth

9. tests Shoulder Drop arm test (-) Empty can test (-) Speed test (-) Neck compression test (-) Lateral compression test (-) Elbow Mills test (-)

10. Physiotherapy diagnosis Sharp pain at the limit of all active and passive movements due to stiffness characterizes adhesive capsulitis

11. Plan of treatment Short term goals 1. relieve pain (IR for 15 min. twice a week) 2. increase the ROM free active exercises ( pendular /auto assisted elevation/ towelling action) 3.Reduce stiffness in shoulder joint Accessory movements( postero anterior/ antero posterior/caudal glide) 4.Relaxation hold relax/soft tissue massage/stretching Finger kneading on tender spots of upper trapezius

12. Long term goals 1.to increase muscle strength 2.to restore posture shoulder girdle retraction &depression practice advice ( not to sleep on affected side/to follow exercises at home ) 3.To restore shoulder joint movements to regain normal ADLs

13. Justification of treatment Movements are limited by pain and joint becomes stiff later.so pain & stiffness has to be reduced As all the GH movements are limited, should increase ROM Adhesion formation in the joint further restrict movements and it progress to the muscle wasting So muscle strengthening should be. As shoulder girdle elevated due to pain, tight upper trapezius should relaxed to get rid of muscle spasm.

14. Outcome measurements of the intervention Session 1 session2 Flexion 60 72 Extension 28 30 Abduction 42 57 Medial rotation 28 33 lateral rotation 22 28 Improvement of movements At 2 nd session of patient's assessment , pain score has reduced to 4 of VAS scale