C/O

Deep shoulder stretching pain on shoulder abduction NPRS 5/10

No pain at rest
Reduction of pain killer consumption from 2 pills to 1 per day.
Agg: hand behind back movements and over-head movements
Easing: Pain eased immediately by resting arms in a lowered position
24 hr: Morning stiffness+ No night pain currently

OE
Observation: Rounded shoulders
Palpation: no signs of inflammation
Tenderness on palpation of biceps longhead tendon and supraspinatus tendon
Shoulder Active Passive
Flex 160 160
Abd 150, painful at 160
around 90 deg
ER in 90 deg scaption 70 80
IR in 90 deg scaption 75 75

Stiffness plus in active and passive shoulder flexion, abduction and ER

HBB to L1
Power: Flexion, ER, abd grade 4-
Neers impingement and Hawkins kennedy test: -ve
Speeds test: +ve
Pain free in open can and empty can test
Left scapular control worser than right

Physical diagnosis:
Frozen shoulder with impingement and rotator cuff weakness

Problem list:
1. Shoulder stiffness in flexion, abduction and rotations
2. Shoulder impingement
3. Weakness in rotator cuff muscles
4. Poor left scapular control

Rx:
Shoulder active assisted ROM exercises with cane
Shoulder overhead press and shoulder abduction ex with 1 kg dumbbell
Scapular retraction exercise with resistance band
Scapular clock exercise with small ball
Inferior glide exercise for supraspinatus activation
Grade 4 shoulder caudal glide in 90 degree abduction and grade 3 shoulder ER and
abduction mobilization
Reinforcement of shoulder ER and IR exercise at home with resistance band