Rudolph De Wet
Mr. Moratehi J. Sebophe Age 33 March 2010 (1st) MC shoulder pain during
activity.Dx -small supspin
tendinopathyMx -PT + strengthening 4/52Outcome -FNW
Presented again in October 2010
Same complaintsPain free for 2weeks only
Better prepared
Occupation -DrillerHanded -LeftMed Hx -Nil Injury Hx -R clavicle # ‘98
-Back sprain 2000
Mechanism: Chronic overuse injury
Time of injury or Sx: Acute on chronic Severity /10 + 2-5 Time more painfull Constant dull
pain. >activity. >day
Radiate Hand from shoulder Agrevate OR Relieve >90°ant flexion/
abduction. >weight baring
Sensory Sx (numb/ pins&needles / weakness) Ocasional dull pain lat aspect upper
arm. Pins and needles hand +armsPysio or Rehab received
NSAIDS chronicDescription of specific jobNeck pain or stiffness?
Stiff trapezius
Observe (AP +Lat): Wasting / position etc. Muscular, R shoulder slight droop
Active movements: Elevation +scap dyskinesis Ext rot. (90 abd) + weaker + pain
Passive movements: Ext rot. (90 abd) Pain at limit of passive
ext rot Int rot (90 abd) Pain at limit of int
rot
Resisted movements: Ext. rot. 4+/5 Right 5/5 left Subscapularis (Gerber’s Test)
4+/5 Right 5/5 left Deltoid 4+/5 Right 5/5 left Supra Spinatus +tendinopathy
+scap dyskinesisSpeed’s test- Yergason’s test-
Palpation:
Scapula + Bump felt right old fracture
Periscapular R slight <developed
Cervicobrachial Tender + stiffness of neck
Trigger points Nil
Paxinos test *SAT Drawer *Sulcus sign Apprehension & Augmentation Ant slide *O’Brian Crank *Tenell
Neers Hawkins Neural structures contribution to pain (Upper limb tension test)
Adson’s test (mild) Roos
Describes and demonstrates abnormal posture
*Leans forward*Supports drill at +/-100⁰
Thoracic outlet syndrome
Supraspintus tendinpathy
Scapular dyskinesis
Shoulder X-ray -Healed right clavicle fracture with
exostosis -+ Beaking of acromion
C-spine X-ray -↓ disc spaces C5-7 mild
EMG -↓conduction brachial plexus -Carpal tunnel syndrome
Ultrasound -Supraspinatus tendinopathy
Thoracic outlet syndrome
Carpal tunnel syndrome
Supraspintus tendinpathy
Scapular dyskinesis
Orthopeadic consultation
Surgiacal carpal tunnel release was performed firstly
Rehabilitation program.
Trigger points found and treated (scalene muscles)
Pectoral, scalene stretchingSoft tissue mobs + mobs 1st ribScapular dyskinesis -
strengthening focus on serratus ant.
Scapula stabilizing + rotator cuff strengthening
Exercises started up scalled according to pain
Attempt made to elevate right shoulder
Attention to posture and ergonomics occupation specific
*After 4weeks <Sx + strength and >ROM thoracic outlet syndrome still +
Orthopeadic consultation Resection of exosthosis + 1st rib was
performed
Range of motion exercises started day 1 post op.
Program restarted. Always pain free arcs.
After 6weeks returned to work with full range of motion and pain free.
Thorough history + all relevant questions
Thorough, focused and complete clinical examination, including all surrounding structures.
Don’t cut examination short when one positive finding (or diagnosis) is made, as there may be precipitating or secondary effects linked to findings
Watch pt during training to insure correct execution, check for compensatory mechanisms and observe symptoms and signs that may appear only during activity
Interpreting results history taken + clinical examination, a good grasp of anatomy and biomechanics is needed to make the diagnosis and tailor the rehabilitation