DOI: 06/17/2015. The patient is a 40 year-old male field technician who sustained a work-related injury while positioning a work ladder against a utility pole.
MRI of the shoulder dated 09/17/15 revealed supraspinatus tendinosis and to a lesser extent to the subscapularis. There is configuration of the acromion and acromioclavicular joint which may result in impingement. There is stranding on the rotator cuff interval, raising concern for adhesive capsulitis.
Per the PT re-evaluation note dated 06/14/16, patient has attended 24 visits.
Based on the progress report dated 06/15/16, the patient continues to slowly improve, but complains of left shoulder pain. He has pain with overhead activities and reaching behind his back. Pain is mostly anteriorly and laterally. He is doing his exercises and PT.
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Passive Range of motion (ROM) shows forward flexion and abduction to 160 degrees, and external and internal rotation to 40 degrees. Strength testing is 4/5. Impingement sign is positive. Hawkin’s and Neer’s tests are positive.
Patient is currently taking ibuprofen.
Assessments include left shoulder impingement syndrome and unspecified rotator cuff tear or rupture of the left shoulder.
Treatment plan includes additional PT for work hardening and left subacromial cortisone injection to decrease inflammation and speed up her recovery. Patient will continue with modified duty.
Current request is for 1 Left Shoulder Cortisone Injection Under Ultrasound Guidance between 7/5/2016 and
On History- The patient was a 49-year-old Caucasian male with a chief complaint of pain and weakness in R shoulder abduction and external rotation (dominant shoulder). He was a retired baseball player. He has been a baseball pitcher for 12 years before he retired 5 years
One major injury suffered in the shoulder is to the rotator cuff. The rotator cuff is a group of muscles and its surrounding tendon in the shoulder. These muscles and tendons (rotator cuff) serve to stabilize the shoulder. Many athletes are at risk of injuring the rotator cuff through repetitive impact and sudden movements.
A rotator cuff is simply a group of four tendons and muscles that are located right on the shoulder and on top of the humerus bone. (Source 1) The rotator cuff is what controls the shoulder and allows it to move and be mobile. The four main muscles that consist of the tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. (Source 2). Too much wear and tear on these muscles (such as too many thrown fastballs) is precisely what causes the rotator cuff to begin to tear, as well as swelling in the tendons.
Pain was significantly increased with flexion and extension. Sensation is decreased in the bilateral upper extremities. Strength is decreased in the bilateral upper extremities.
Being a dental assistant can be very challenging when it comes to posture and sitting properly. There are several musculoskeletal disorders that can affect your job in the long run. Some so severe you may have to have surgery!! I don’t think we want that.
Shoulder impingement is a common injury among athletes or those who have physically demanding jobs. The shoulder impingement occurs as a result of the rotator cuff tendons becoming compressed against the bone. As time progresses, the compression area will become inflamed and swollen. The irritation will create a sensation of pain and limit movement in the shoulder. An expert
X ray & MRI or ultrasound are usually used to show the swelling around the tendon and to detect that there is a another problem that could be causing the another symptoms
The soleus, gastrocnemius and tibialis anterior contract isometrically to keep the ankle stable at 90 degrees (Teachpe.com n.d.) (The previous reference was used to identify key joint types and muscles throughout my analysis). The knee joint is extended when in the standing position, to stabilize this joint the biceps femoris, semi-mebranosus, semi-tendonosus (hamstrings) and the rectus femoris, vastus lateralis, vastus transcriptis and vastus medialis (quadriceps) co-contract isometrically. The vertebral column of the body remains stable due to the isometric co-contraction of the erector spinae, rectus abdominus and the external and internal obliques.... ...
The first 6 weeks are considered Phase I, which only aloud to do PROM. Patient will be in the healing phase during this time. Until proximally to 6 weeks post op no AROM is permitted. The patient had a home exercise program from hospital up to 3 times per day. We continued and added some exercises to the program. He is using eis on his shoulder 3-4 times per day for up to 20 minutes. Also, keep his arm in sling, and removes
Patient returned the next day still complaining of pain. The PT applied heat, then initiated the exercise program, but the patient could not perform theem to same extent as previously, secondary to pain. Therefore, the PT told the patient to schedule an appointment with his physician. The patient was seen by the MD the next day and an arthrogram performed that revealed a reinjure to the repaired site. And a second surgery repaired the rotator cuff.
When performing manual muscle testing for shoulder flexion and abduction, PTA’s typically place their hand at the wrist verses the mid-extremity because placing their hands at the wrist increases the length of the lever thus testing the muscles ability to resist externally applied force overtime and across the bone-joint lever arm system. Shorter lever arms will provide higher testing scores when compared to using longer lever arms, thus changing the point of force application affects the length of the lever arm and therefore the muscle torque.
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn
This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss.
The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture.
Physical therapy is a fun and exciting healthcare profession that helps people. It is all about helping other people who have problems with their body, muscles, joints and other parts of their body. Patients includes accident victims and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Physical therapy will perform an evaluation of your problem or difficulty. They evaluate your problem by performing tests and measures to assess the problem. These tests includes muscle strength, joint motion, sensory and neurological, coordination, balance, observation, palpation, flexibility, postural screening, movement analysis, and special tests are designed for a particular problem. Next, they develop a treatment plan and goals and then manage the appropriate treatment to aid in recovery of a problem or dysfunction. Physical therapists are able to treat their patients by using many different treatments depending on the type of injury. Some of the treatments are electrical stimulation, hot and cold packs, infrared and ultrasound to reduce swelling or relieve pain. These treatments are used to help decrease pain and increase movement and function. Therapeutic exercises instructions will help restore strength, movement, balance, or skill as a guide towards full functional recovery. Physical therapy provides "hands on techniques" like massage or joint mobilizations skills to restore joint motion or increase soft tissue flexibility. They will focus on basic skills such as getting out of bed, walking safely with crutches or a walker, moving specific joints and muscles of the body. Physical therapists treatment includes patient education to teach them how to deal with a current problem and how to prevent the problem in the future. Such documentation is used to track the patient's progress, and identify areas requiring more or less attention. They encourage patients to use their own muscles. Their main goal is to improve how an individual functions at work and home.