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