A 45-year-old man enters the outpatient physical therapy department with a compl

Question

A 45-year-old man enters the outpatient physical therapy department with a complaint of rightshoulder pain of 1 week’s duration. The pain began Monday morning following a weekend of scrapingand painting his house. The patient describes his pain as aching and troublesome; his pain is a 6on a pain scale of 0 to 10. He reports that he is married, and having difficulty in home maintenanceactivities such as lawn mowing. He is able to perform only 30% of his normal home and recreationalactivities. The therapist decides to conduct a musculoskeletal examination.While palpating the shoulder region, increased tenderness and skin temperature in the region ofthe bicipital groove of the right anterior shoulder is noted. Active ROM of the right shoulder revealsincreased pain and some limitations during shoulder flexion, abduction, and extension; all other activemotions are pain free and within normal ROM limits. Passive shoulder motions are pain free withnormal ROM, except for shoulder extension, which is limited and causes an increase in pain towardthe end of motion. QUESTIONS1. What additional information should be gathered during the interview?2. What is a capsular pattern of limitation? Does this patient have a capsular pattern of limitation for the glenohumeral joint?

Explanation / Answer

Ans> 1) onset of symptoms :- following leading questions help in this assesment
a) when did the injury occur. In relation to the onset of symptoms.i.e. immediately preceding or a few days or weeks before.
b) how did the injury occur? i.e. to assess wheather severity of the trauma was sufficient to cause whatever the patient complains of and also to known the exact mode of the injury.
c) did the patient have symptoms (such as pain,swelling,etc) immediately following the trauma or did they occur after a few days or weeks?
d) was the patient able to carry on his activities dispite the "INJURY"?
e) was thee patient given any treatment? did he get any X-ray done at time?these suggested that the injury was serious enough.
it is a fact that sometimes there may be a long period between the injury and onset of symptoms
swelling :- swelling, with or without pain, is a common complaint. When without or with a little pain. it is due to a benign growth or a low grade malignant growth. swelling following a fracture may be due to callus formation or displacement at the fracture site. swelling associated with pain is due to inflamatory or neuroplastic disorders. the way the swelling progresses indicates its etiology.

common complaints of an orthopaedic patient :-
pain
a) what is tha exact site of the pain? try to be specific as possible. it helps to ask the patient to point to the site of pain.
b) does the pain radiate to some other area? it is common in limbs to have pain originate in one part and radiating to another part.
c) is the pain at all times? a pain due to neoplasia is present at all times it may flucuate but is present. a pain due to trauma is maximum within 4-6 hoursof injury and than start susiding
d) what aggravates or relieves the pain? a pain of mechanical origin becomes worse with activityand improves with rest. on the other hand a pain of chronic inflammation like osteoand rehumatoid arthritis comes up after a period of rest and improves with activity.
e) what term can best describe pain?this sometimes helip in localising the cause of the pain.
f) are there any other symptoms associate with pain?in most of the painful conditions of inflammatory, neoplastic or traumatic origine, the pain is associated with swelling.

Ans> 2) adhesive capsulitis or frozen shoulder is a painful disorder of without ligiable cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder become inflammed and stiff. pain is commonly constant worse at night and cold weather.the condition is thought to be caused by injur or trauma to the site and may have an autoimmune component.

joint - capsular pattern
a) glenohumerol - lateral rotation, abduction, medial rotation
b) sternoclavicular - pain at extreme range of movement
c) acromioclavicular - pain at extreme range of movement
d) humeroulnar - flexion, extension

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