CASE STUDY
- CLINCAL SKILL TRAINING II
- BPT SEM VI
PRACHI
2240991643
DEMOGRAPHIC DATA
Name Nidhi
Age – 56 years
Gender – Female
Occupation –Housewife
Address – 22 sector chandigarh
Date of Assessment – 1st Jan 2025
CHIEF COMPLAINT
Patient complaints of severe pain and restricted
movement in the right shoulder from the past 5
months and it is affecting activities of daily living .
HISTORY
Present history – Severe pain and restricted movement
in the right shoulder since the past 5 months .
Past history – Relevant information not obtained
Surgical history – No
Medical history - Diabetes
Personal history – Non smoker , Non alcoholic
Socio-economical status – Middle class family
Onset of pain – Gradual
Site of pain – Right shoulder
Aggravating factors – Worsen with shoulder
movements – dressing , combing , cooking , etc.
Relieving factors – Resting , lying
PAIN ASSESSMENT
Location of pain – Right shoulder
Distribution of pain – Radiating to right arm
Duration of pain – 5 months
Behavior of pain – Constant dull aching pain
Severity of pain – 8/10 [ numerical pain rating
scale ]
NUMERICAL PAIN RATING SCALE
OBSERVATION
GENERAL OBSERVATION
• Body build – Mesomorphic
• Wound – Nil
• Posture – Normal
• Gait – Normal
• Deformity – No
• Edema – No
LOCAL OBSERVATIONS
• Scars / sutures – No
• Swelling – Mild
• Any external devices - No
PALPATION
Tenderness – Grade 2 Tenderness at anterior and
lateral aspect of shoulder
Temperature –slightly warm
Crepitus formation – No
Muscle wasting - No
INVESTIGATION AND
DIAGNOSIS
INVESTIGATION DIAGNOSIS
MRI Confirms adhesive Frozen Shoulder
capsulitis .
EXAMINATION
RANGE OF RIGHT LEFT
MOTION
Shoulder flexion 0°- 90° 0° - 171°
Shoulder 0° - 30° 0° - 58°
extension
Shoulder 0° - 70° 0° - 180°
abduction
Shoulder 70° - 0° 180° - 0°
adduction
Shoulder 0° - 50° 0° - 64°
internal rotation
Shoulder 0° - 30° 0°- 87°
external rotation
Passive ROM:
Flexion : 0° - 110° (with pain at the end range)
Extension : 0° - 35° (with slight discomfort)
Abduction : 0° - 80° (with significant pain)
Adduction : 80° - 0°
Internal Rotation : 0° - 53° (painful)
External Rotation : 0° - 32 (very painful)
EXAMINATION
MANUAL RIGHT LEFT
MUSCLE TESTING
Shoulder flexors 2+ 4
Shoulder 2+ 5
extensors
Shoulder 2+ 4
abductors
Shoulder 2+ 5
adductors
Shoulder 2+ 4
internal rotators
Shoulder 2 4
external rotators
GOALS
SHORT TERM GOALS LONG TERM GOALS
• Pain Management • Improve strength and
• Improve / Maintain able to perform the
range of motion daily activities
• Improve functional
activities
PHYSIOTHERAPY
MANAGEMENT
ELECTROTHERAPY
1. TENS – Transcutaneous electrical nerve
stimulation
Position of the patient – Supine lying
Frequency – 80 Hz -100 Hz
Duration – 10 min
Intensity – According to the patients tolerance
= To reduce pain by blocking pain signals and to
promote muscle relaxation
2. Hot Packs
Position of patient – Supine lying
Duration – 15 min
= To reduce pain and promote vasodilation , increase
range of motion .
3. Ultrasound
Position of patient – Short sitting
Intensity – 0.8 MHz
Duration – 5 min
= To promote healing and break adhesions
EXERCISE THERAPY
1. Mobilization :
15-20 Glides and 3 sets
= To improve joint mobility and restore normal
functioning
2. Strengthening exercises :
- Isometric shoulder exercises -
10 sec hold with 10 time repetition in each direction ,
twice daily .
- Resistance bond exercises -
For shoulder internal and external rotation – 10 sec hold
with 10 repetition , twice daily .
- Passive range of motion exercises :
3 sets of 10 repetition twice daily
3. Pendulum exercises :
Use body weight to gently swing the arm in a circular
motion .
3sets of 10 repetition , twice daily
you
Thank
