It's about a case presentation of Musculoskeletal Module which i have done regarding "supraspinatus Tendinitis"

1. Case Presentation
(Musculoskeletal Module)
M.I.M Ayaz
UCP/AL/11/187

2. Subjective Examination
Personal Information
• Name : Mr. X
• Age : 57 yrs
• Gender : Male
• Occupation: Bus Driver
• Address : Kelaniya
• Civil Status: Married
• Children : 2 sons and a daughter
• Health Risk : DM+

3. History of Present Complaints
• 2 yrs ago, when he was driving the bus he suddenly
felt a sharp pain over the left shoulder and had a
difficulty to change the gear.
• But after having some analgesic drugs it
disappeared and rarely present.
• 2 months ago when he was lifting his grand
daughter severe pain occurred over the same
area.
• Pain has increased gradually.

4. Present Complaints
• Severe aching pain often present around the left
shoulder joint.
• Sometimes it reffered to the lateral aspect of the
arm
• Difficulty to perform day to day activities
Eg : Unable to sleep on the affected side.
Difficulty to lift heavy weights by the affected
side.

5. Objective Examination
Observation
• Informal Observation :
Looks like a healthy man with slightly depressed mood
• Formal Observation :
Had been done by looking at the patient anteriorly,
laterally and posteriorly while he was in sitting as well
as standing.
Scapula levels were equal, slight prominent acromian
process of left side, slight muscle wasting of left side
(deltoid & supraspinatus), No skin colour changes, little
bit swelling around the left acromian process

6. Objective Examination Cont…
Palpation
• Tenderness below the left acromion process
• Pain increased with palpation
• Slight Muscle spasm over the Left shoulder area
• Left acromion was prominent
• No temperature changes

7. Test
AROM
PROM
Muscle Power
Spec. Test
Objective Examination Cont….
Test

8. Mobility chart of the Shoulder Joint taken on 07/02/2015
Movement
Normal
Range
Right Side Left Side
(X °) Active Passive Active Passive
Flexion 180 180 - 180 180
Extension 60 60 - 40 55
Adduction 45 45 - 35 40
Abduction 180 180 - 73 140
Internal Rotation 70 70 - 60 70
External Rotation 90 90 - 52 85

9. Measured ROM of other relative joints
• Neck Movements Normal
• Elbow Joint Normal
• Wrist Joint Normal
Muscle power testing according to the muscle
grading scale (Left Side)
• Flexors– 5
• Extensors – 5
• Abductors – 3
• Adductors – 5
• Internal Rotators – 5
• External Rotators - 4

10. Special Tests
• Speed Test -ve
• Drop arm Test -ve
• Anterior and Posterior drawer Test *
• Supraspinatus Tendinitis Test +ve
• Apley Scratch Test +ve
• Hawkings kennedy impingement Test +ve
Physiotherapy Diagnosis : Supraspinatus Tendinitis of
Left Shoulder Region,
secondarily Frozen Shoulder

11. Treatment Plan
Objectives
• Relieve the pain
• Increase the ROM
• Reduce Muscle spasm
• Restore general muscle strength
• Prevent Recurrence and Educating the patient
Short Term Goal – Relieve the pain
Long Term Goal – Bring the patient back to the normal
functional level

12. Treatment Plan cont….
At Early Stage
• Ultra Sound Therapy – continious mode, 0.8 W/cm2,
4 min, 1 MHz, thrice a week
• Soft Tissue Mobilization - Transverse friction to the
area
• Ice therapy – after the transverse friction
• Active Exercises
At Final Stage
• ROM Exercises
• Relaxation Exercises
• Muscle Strengthning Exercises

13. Justification of the treatment plan
• Ultra Sound Therapy to relive pain, increase
circulation, increase removal of waste products
and as a micro massage
• Transverse friction to break adhesions
• After friction cryotherapy can be given to warmth
area
• Active Exercises /AROM Exercises to improve ROM,
to improve muscle properties and to prevent
forming contractures
• Relaxation Exercises to increase joint mobility
• Strengthning Exercises to Strength weak muscles
and improve muscle power
• Educate the patient to get the cooperation for the
treatment plan

14. -Thank You-