CASE NO: 2

KNEE OSTEOARTHRITIS
Mrs Laila, a 69-year-old woman, presented to the outpatient department
complaining of pain in both knees. The patient claims that one year ago,
she began experiencing considerable pain in the medial sites of both
knees, which was limiting her everyday activities. Walking and taking a
rest can help to ease the pain, which is increased by prolonged standing
and sitting, knee bending, and stair climbing and descending. She had a
hysterectomy and Covid in the past. She is a widow living alone in DHA
she comes from an upper-class family and is now financially
independent as she is retired.
ASSESSMENT:

On assessing patient she has presented with hip muscle weakness

and is more prone to increase in medial compartment loading on the
knee joint

 flexion and extension was limited due to stiffness and formation

of osteophytes in the joint

 Strength is  reduced due to pain and deconditioning

  swelling, temperature changes, joint line tenderness was also

found

Coordination Test: She was able to perform finger to nose test correctly, her
coordination was good.
Scales Scoring:

1. MINI-COG and CDT:

Her total score was 5. She was able to recall all 3 words and drew a good
clock with right time hence no sign of dementia.

2. KATZ INDEX of Independence, Activities of Daily Living (ADLs):

Her total score was 3/6. She needed assistance in Physical Ambulation,
bathing and toilet.

3. (LAWTON- BRODY) Instrumental Activities of Daily Livings (IADLs):

His score was 3/8. She needed assistance in housekeeping, shopping

 cooking, travelling and laundry. As she can’t stand for long period of time.

4. (TINETTI) Performance Oriented Mobility Assessment (POMA):

Her sitting balance was 7/16.

5. POMA (Gait Section):

Her score was 6/12. She was not able to maintain good balance while
standing and in gait. Total gait score was (6+7) =13, 13/28 which means she
has high risk of falling.

6. BARTHEL INDEX:

His score was 80/100, which shows slight dependency.

GOALS
SHORT TERM
 To reduce pain
 To reduce swelling
LONG TERM
 To strengthen muscles around knee
 Postural correction

REHABILITATION PROTOCOL:
SESSION: 01
 TENS for 15 mints

 Cold pack to reduce muscle spasm

 Static quads 10 reps

 Ankle pumping 15 reps in each

 Maitland patellar glides

 HOME PROGRAM
 Apply hot pack 3 times a day

 Pillow squeeze exercise 10 reps

 Self-stretching of hams

SESSION: 02
TREATMENT:
 Tens for 15 minute

 Hot pack

 Knee flexion exercise

 DTFM for tenderness

 AP glide on tibia 30 reps 3 sets grade 1 and 2

 Static quads 10 reps

 Medial and lateral glides grade 1 and 2

HOME PROGRAM
 Self-stretching of hams

 Pillow squeeze exercise

 Walking 15 mints max daily

 CASE NO: 3
ADHESIVE CAPSULITIS
Fareed-ud-din, a 67-year-old male came in OPD with the complaint of left
sided shoulder pain and stiffness. With history of fall and diabetes and
hypertension. According to the patient, he is a stall owner and works for
more than 12 hours per day. 6 months ago he suddenly started feeling
needle like pain in his left shoulder till arm and fingers and for that he
just took pain killers and continue to go to his work. But now the
intensity of pain has increased and he is unable to move his shoulder
and it is affecting his daily earnings. He lives in Malir line with Family. He
couldn’t sleep at night because of intense pain. He is diabetic and is on
medicines.
ASSESSMENT:
On examination, patient was sitting with guarding posture (shoulder flex,
adducted and slight shrug with elbow flexion). He has pain in active and
passive movements (flexion, abduction, external and internal rotation).
 Spurling Test was negative with no increase or decrease in pain or
numbness.
 ULTT for median and ulnar nerve increased his pain.

Coordination Test: He was able to perform finger to nose test correctly,

his coordination was good.
Scales Scoring:

1. MINI-COG and CDT:

His total score was 5. He was able to recall all 3 words and drew a
good clock with right time hence no sign of dementia.
2. KATZ INDEX of Independence, Activities of Daily Living (ADLs):

His total score was 2/6. He needed assistance in dressing and

grooming, bathing and toilet. Probably because of tight anterior
capsule making it painful to do overhead activities.

3. (LAWTON- BRODY) Instrumental Activities of Daily Livings

(IADLs):
 His score was 3/5.

4. (TINETTI) Performance Oriented Mobility Assessment (POMA):

His sitting balance was 11/16.

5. POMA (Gait Section):

His score was 12/12. He was able to maintain good balance while
standing and in gait. Total gait score was (11+12)=23 , 23/28
which means he has moderate risk of falling

BARTHEL INDEX:

His score was 65/100, which shows dependency.

GOALS
SHORT TERM
 Decrease pain
 Improve strength,
LONG TERM

 Increase range of motion (ROM)

 Functional independence.

REHABILITATION PROTOCOL:
SESSION: 01
 Downward traction with lateral rotation of shoulder (to relieve pain
and increase range of motion of shoulder joint) (3 reps - 5 sec hold
each)
 AP glides on shoulder (to relieve pain and improve extension and
external rotation) (30 reps)
  PA glides on shoulder (to relieve pain, stretch anterior capsule and
improve flexion and internal rotation) (30 reps)
 Caudal glides on shoulder with arm in abduction (to improve
abduction and flexion) (30 reps)
 Chin tuck in while towel under cervical (to improve posture,
decrease pain and relax muscles) (10 reps)
 Ultrasound on ant shoulder (to reduce pain and relax tight muscles
to improve range of motion) (for 10 mins)
 Ice pack (to relieve pain) (for 10 mins)
Home Exercise Plan: Towel stretch exercise for shoulder mobility, Door
holding exercise for pectorals stretch, Retraction exercise (try to bring
your shoulder blades together on couch), Cross body stretch, Told
patient to wear his shirt from the affected shoulder side and take it off
from the sound side (to help him in dressing independently). We advised
the patient to follow these exercises regime in order to help him in doing
his ADLS and maintain the range.
SESSION: 02
 Downward traction with lateral rotation of shoulder (to relieve pain
and increase range of motion of shoulder joint) (3 reps - 5 sec hold
each)
 AP glides on shoulder (to relieve pain and improve extension and
external rotation) (30 reps)
 PA glides on shoulder (to relieve pain, stretch anterior capsule and
improve flexion and internal rotation) (30 reps)
 Caudal glides on shoulder with arm in abduction (to improve
abduction and flexion) (30 reps)
 Soft tissue (lifting technique) for pectorals minor (to stretch pec
minor muscle)
 Chin tuck in while towel under cervical (to improve posture,
decrease pain and relax muscles) (10 reps)
 Ultrasound on ant shoulder (to reduce pain and relax tight muscles
to improve range of motion) (for 10 mins)
 Ice pack (to relieve pain) (for 10 mins)
Home Exercise Plan: Towel stretch exercise for shoulder mobility, Door
holding exercise for pectorals stretch, Retraction exercise (try to bring
your shoulder blades together on couch), Cross body stretch, Told
patient to wear his shirt from the affected shoulder side and take it off
from the sound side (to help him in dressing independently). We advised
the patient to follow these exercises regime in order to help him in doing
his ADLS and maintain the range