Patient: Mr.s M/54 y.

o/11492722/laboratory worker/Malang
Referred from: -
Resident: NAN
Positive Findings Problem List Diagnose Planning

Anamnesis: Medical: Frozen shoulder, Clinical diagnoses: PDx: -

Rotator cuff tendinitis Low Back Pain d.t multiple PTx:
• Pain on right shoulder since 3 weeks ago. canal stenosis + HT Continue medication
• Pain was felt sharp, radiating to upper Modality:
Surgical: -
right arm, occurred most of the time, Functional diagnoses: - NMES at hip flexor, ankle dorsiflexor,
worsened by doing activities, relieved Impairment: long toe extensor right LE , intensity
R1 (M): - low back pain, right lower 70-85 ppm, frequencies on-time 5-15 s,
by rest and pain medications, VAS 5 R2 (A): - extremity monoparese, muscle off-time 50 s-2 min, duration minimal
• Tingling sensation (-), reduced R3 (C): - weakness, paralumbal muscle 10 repetition, 2x/week.
sensation (-) R4 (P): worried about her spasm, sensory deficit, HT, - SWD at paralumbal, frequency
• Stiffness of the right hand since 3 weeks ago. condition reduced breathing capacity 27,12 MHz, intensity as patient
R5 (S): - tolerance, duration 15 min,
• Patient was able to use the hands but Disability: 2x/week
R6 (V): Difficulty when
felt weaker to grip objects working discomfort in sitting Exercise:
• No bladder/bowel problem
R7 (O): limitation in standing, and • Strengthening exercise of LE R/L
• no difficulty to speak, no difficulty to swallow, no walking • Active assistive ROM exercise right
vision loss Right shoulder pain & limitation in doing ADL LE
• History: trauma (-), DM (-), hypertension (-), limitation • Breathing exercise
malignancy (-) Handicap: OT:
• Medication: NA diclofenac, voltaren limitation of social activities - Sensory resensitization
• BI: 100. inability to work Endurance: hand cycle

2
PMo:
VAS, MMT, ADL, sensoric improvement
Barthel Index

100
Patient: Mr.s M/54 y.o/11492722/laboratory worker/Malang
Referred from: -
Resident: NAN

Positive Findings
Physical examination: • A/r Shoulder (D):
• GCS: E4M6V5, CM • Inspection: • Sulcus sign -/-
• BP: 137/89 mmHg • Deformity (-) • Neer’s sign test -/-
• Pulse: 89x/min • Edema (-) • Hawkin test -/-
• RR: 20x/min • Erythema (-)
• Empty can test -/-
• Gait: Normal gait • Palpation:
• Tenderness (+) • Patte test -/-
• Cranial Nerves: CN I-XII (N) • Lift-off test -/-
• Warmth (+)
• Sensory deficit : (-) • Move: • Drop arm test +/-
• Proprioception deficit: (-) • ROM- Limitation • Yergason’s test -/-
• Physiological Reflexes: • Apley scratch test
• BPR +2/+2 TPR +2/+2 • Ext. rot & abduction- Unable to reach
• KPR +2/+2 APR +2/+2 ipsilateral ear
• Clonus -/- • Int. rot & adduction- Ipsilateral
• Pathological Reflexes: posterior pelvis
• Hoffmann -/-, Tromner -/-, Babinski -/-, Chaddock -/-,
Oppenheim -/- SHOULDER Active ROM Passive ROM MMT
• Autonomic System : (-) Flexion F/F (0-1800) F/F (0-1800) 5/5
• ROM: UE Limited/F Neck- Full Extension 0-300/F (0-600) F/F (0-600) 3/5
LE F/F
• MMT: UE decreased/5 Neck- 5 Abduction 0-200/F (0-1800) 0-700/F (0-1800) 3/5
LE 5/5 Adduction F (Pain)/F (0-450) F (Pain)/F (0-450) 3/5
Internal rotation 0-600/F (0-700) 0-600/F (0-700) 3/5
External rotation Pain /F (0-900) NA /F (0-900) 3/5
 ICF
Diagnosis
Body S720 structure of shoulder region
Structu
re
Body B280 sensation of pain
Functio B710 mobility of joint function
n
Activity D430 lifting & carrying objects
& D699 domestic life
D999 community, social, civic life
Particip
ation
Frozen Shoulder
Arthrology of GH Joint
The rotator cuff fails to cover two regions of
the capsule: inferiorly, and a region between
the supraspinatus and subscapularis known
as the rotator interval.
Reinforced by the tendon of the long head of
the biceps and the coracohumeral ligament.

The long head of the biceps restricts anterior

& superior translation of the humeral head.
6 Kinematic Principles Associated
with Full Shoulder Abduction
Principle 1: Based on a generalized 2:1 scapulohumeral rhythm, active shoulder abduction of about 180
degrees occurs as a result of simultaneous 120 degrees of glenohumeral (GH) joint abduction and 60
degrees of scapulothoracic upward rotation.

Principle 2: The 60 degrees of upward rotation of the scapula during full shoulder abduction is the result
of a simultaneous elevation at the sternoclavicular (SC) joint combined with upward rotation at the
acromioclavicular (AC) joint.

Principle 3: The clavicle retracts at the SC joint during shoulder abduction.

Principle 4: The scapula posteriorly tilts and externally rotates during full shoulder abduction.

Principle 5: The clavicle posteriorly rotates around its own axis during shoulder abduction.

Principle 6: The GH joint externally rotates during shoulder abduction.

6 Kinematic Principles Associated
with Full Shoulder Abduction
Soft Tissue Lesions
Adhesive Capsulitis
Decreased shoulder range of motion, especially external rotation & abduction, associated with
shoulder pain.
Have an irregular capsular margin and a longer duration of shoulder pain.
However, adding an irregular capsular margin caused limitation in shoulder flexion.
Shortening of the joint capsule and ligaments that are largely extensions of the capsule that is caused
by process of inflammation.
Impaired Motor Control
Changes in muscle tone
Spasticity
Defined as an increase in muscle tone caused by hyperexcitability of the stretch reflex and is characterized by
a velocity-dependent increase in tonic stretch reflexes.
Usually begins at late phase of stroke.
M. Subscapularis is most commonly affected.
Therefore, movements of external rotation, abduction & flexion is commonly the most limited ROM with the M.
Subscapularis muscle being spastic.

Abnormal muscle tone → abnormal scapulohumeral rhythm → impingement of the rotator cuff or
other structures in the subacromial space.
Spasticity may cause Adhesive Capsulitis.