ORTHO CASE

PRESENTATION
Prashanth MP​
Name – Gowtham
Age – 30
Gender – Male
Occupation – Garments worker
Address – Chandapura
DOA – 31/5/23
Date of Assessment – 08/6/23
Chief Complaint – Patient complaints of left shoulder pain since 1 week while doing overhead
activities and had difficulty in rising the hand for prolonged time while working in the
garments and also faces difficulty in wearing his pants
History Of Present Illness – Patient had a sudden fall on his left side shoulder and got hit by a rod
three months back . A day later he went to his native to show his aching shoulder to a local
doctor . The doctor took X-ray diagnosed a left anterior glenohumeral dislocation and corrected
it . The doctor advised him to return to his daily activities the patient did so . Until one week back
when pain aggravated . So he came to Ortho dept of Oxford Medical College and Hospital from
where he was referred to dept of physiotherapy
Personal History – Smoking – No
Alcohol – No
Family History – Not Significant
Socio-economic History – Lower Middle class (Acc to Kuppu swamy scale)
Environmental History – He lives alone in his house where he has to do all his daily activities by
his own and at garments he has to rise his hand for more than 2 – 3 hours continuously .
Medical / Surgical History - No
Comorbidities – No
Drug History – Zerodol SP
Pain History –
Onset – Sudden
Site – Anterior Shoulder
Side – Left
Duration – 3 months (Chronic)
Type – Localized
Aggravating Factors – Overhead activities
Reliving Factors – At rest
Severity – NPRS At rest – 3 At Activity - 7
Diurnal Variation – Pain is more at day time while working
Associated Factors – None
On Observation –
Body build – Mesomorphic
Attitude of Limb – Normal
Posture – Normal
External Appliances – No
Oedema – Absent
Scars , wound, bandages – Absent
Gait Pattern – Normal
Tropical changes – Absent
Patient Behaviour - Cooperative and well oriented
On Palpation –
Tenderness – Present (Grade – 1 – Patient complaints of pain at anterior deltoid muscle)
Warmth – Present
Spasm – Absent
Crepitus – Present
Trigger point – Absent
Swelling – Absent
On Examination –
Shoulder ROM –
Flexion – Active – right – 0 – 175 Passive – right – 0 – 180 Normal – 0 – 180
left – 0 – 155 left – 0 – 158
Extension – Active – Right – 0 – 55 Passive – Right – 0 – 60 Normal - 0 – 60
Left – 0 – 55 Left – 0 – 60
Abduction – Active – Right – 0 – 170 Passive – Right – 0 – 175 Normal – 0 - 180
Left - 0 – 150 Left – 0 – 155
Internal Rotation – Active – Right – 0 – 70 Passive – Right - 0 – 70
Left – 0 – 70 Left - 0 – 70
External Rotation - Active – Right - 0 – 85 Passive – Right – 0 – 90
Left 0 – 15 Left 0 – 20
Shoulder MMT –
Flexion (Deltoid anterior fibres , Coracobrachialis) – Right - Grade – 5
Left - Grade – 4
Extension( Latissimus dorsi , Deltoid posterior fibres , Teres major) – Right – Grade – 5
Left – Grade – 4
Abduction(Deltoid middle fibres , supraspinatus) - Right – Grade – 5
Left – Grade – 4
Adduction(Pectoralis Major) Right – Grade – 5
Left – Grade – 4
Limb Length – True Limb Length – Right – 80 cm
Left – 82 cm
Apparent Limb Length – Right – 60 cm
Left – 62 cm
Special Tests –
1 . Apprehension Test –
Patient Position – Patient in supine with shoulder 90 degree abduction slowly take shoulder
into external rotation
Positive sign – Patient does not allow shoulder to move in direction to stimulate anterior
dislocation
2 . Dugas Test –
Patient Position – Patient in a sitting position ask a patient to place one hand on opposite shoulder
and lower the elbow to the chest
Positive sign – Pain causes inability to do the movement
Outcome Measures –
SPADI –
At pain – 31/50
Difficulty – 52/60
Investigations –
X-ray
Problem Lists –
ICF
Body Structure and Function –
To reduce pain
Reduce muscle weakness
Activity Limitations –
Regain Left hand movement
Couldn’t sleep on his left side
Participation –
Difficulty in rising hand for long time while working in garments
Wearing his pants
Goals –
Short term goals –
To reduce pain NPRS from 7 – 5
To improve full ROM
To strengthen the weakened muscle
To prevent the re- occurrence
Long Term goals –
To reduce the pain to NPRS – 2
To do his daily activities
THANK YOU