PT Master Guide

Category: Uncategorised

  • Supraspinatus Tendonitis And Shoulder Examination

    Supraspinatus Tendonitis is often associated with Shoulder impingement syndrome impingement and inflammation of Supraspinatus Tendon is called Supraspinatus Tendonitis

    EPIDEMIOLOGY AND CAUSES

    Mostly affects sports athlete often result from overuse injury with sporting activities like throwing and overhead motion apart from this it also affects age group of 50-60 years with prevalence more in patients with diabetes

    Factors affecting listed below

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    CLINICAL FEATURES

    Subdeltoid pain is the most highlighting feature which aggravates with abduction movement Pain also felt while reaching,overhead activity, sleeping on affected shoulder It become worse during night and often disturbs sleep

    Painful and limited range of motion and painful arc 70°-120°

    Their is anterior instability along with posterior tightness

    PHYSICAL EXAMINATION AND DIAGNOSIS

    Following physical examination used to evaluate Supraspinatus Tendonitis

    Testings:

    Neer test

    Hawkins Kennedy Test

    Empty Can Test

    Drop Arm Test

    Impingement test

    Complete description on how to perform following tests along with other important physical examination of shoulder injury is given below

    Shoulder Examination

    X-ray Radiography shows calcified lesion around Supraspinatus tendon later cases shows degenerative and sclerotic changes Ultrasound reveals thickening of subacromial bursa

    DIFFERENTIAL DIAGNOSIS

    AC Joint Injury

    Clavicle injury

    Rotator Cuff tear

    Swimmer’s Shoulder

    Impingement Syndrome

    Osteoarthritis

    Biceps Tendinitis or Tendinopathy

    MEASURES AND SCALE

    Simple shoulder test questionnaire

    Oxford Shoulder Score

    PHYSIOTHERAPY MANAGEMENT

    Medical management includes Corticosteroid injection, NSAIDS that alleviates pain and surgical procedures include subacromial decompression, sometimes acromioplasty, bursal resection. Physiotherapy management includes Rest, Ice, pain relieving modalities like ultrasound, cryotherapy, Electrical Modalities Stimulation. Their are three phases of Supraspinatus Tendonitis management which includes (a) Immobilisation (b) Assitive range of motion (c) Progressive resistance exercise

    ROM exercise, Strengthening exercise, Stretching techniques, Isometric exercises, Codmans classic pendullar exercise and Kinesiotaping, soft tissue manipulation like MFR, IASTM are also prescribed and found to be very effective in pain relief and regaining range of motion. Along with these Home exercise programs, self exercise regimes are also advised

    For more details visit

    https://www.physio-pedia.com/Supraspinatus_tendinopathy#Epidemiology.2FEtiology

  • Frozen Shoulder aka Adhesive Capsulitis

    also known as adhesive capsulitis basically is an inflammatory painful stiff condition of shoulder joint that develops gradually causing pain which can get worse at night and limits shoulder range of motion.

    EPIDEMIOLOGY

    It involves individual aging between 40-70 years with mean prevalence of 30% patients with diabetes with higher majority of prevalence among type-1 diabetes patients and lifetime prevalence of frozen shoulder is estimated around 2-5% among general population

    CLINICAL FEATURES AND PATHOPHYSIOLOGY

    Frozen shoulder can be Primary (Idiopathic) or Secondary (due to any underlying disease) It consists of 3 stages viz. 1. Painful stage 2. Freezing stage 3. Thawing stage Clinically presented with

    Pain, Loss of Range of motion, Stiffness

    Pain is not localised may radiate to biceps area and deep seated pain in nature it may be localised around anterior or posterior capsule.

    PHYSICAL EXAMINATION AND DIAGNOSIS

    Adhesive Capsulitis hallmarks loss of range of motion so examine Range of shoulder motion in all planes and movements viz flexion, extension, abduction, adduction, internal and external rotation

    For internal rotation its recommended to use Apley’s scratch test

    Palpation may reveal diffuse vague tenderness over anterior and posterior shoulder

    If loss of motion is observed therapist may apply scapular stabilization and assist movement for accurate testing

    Radiography is not that useful however can be performed to rule out other pathology MRI may reveal capsular thickening Basic diagnostic tool is physical examination ROM testing,Palpation etc

    Indexes included for measuring frozen shoulder pain and disability

    Shoulder Pain and Disability Index

    Disability of Shoulder and Hand

    Simple Shoulder test

    Penn Shoulder Scale

    VAS etc

    DIFFERENTIAL DIAGNOSIS

    Osteoarthritis Shoulder

    Rotator Cuff Pathology

    PTS syndrome

    Biceps tendinopathy

    Bursitis

    TREATMENT

    Medical management include use of corticosteroids, NSAIDS, Intracapsular Corticosteroid injection etc Surgical Management include Arthroscopic surgery, joint manipulation under anaesthesia to break adhesions but has moderate evidence to alleviate pain Physiotherapy is the cornerstone for frozen shoulder techniques include shoulder manipulation and mobilisation, ROM exercise, stretching techniques, Strengthening exercise, Modalities such as ultrasound, iontophoresis, cryotherapy, TENS are used to relieve pain. Physiotherapy along with Corticosteroid injection do miracles and help in long term relief

    For Stretching and Strengthening exercises for frozen shoulder visit

    https://www.health.harvard.edu/shoulders/stretching-exercises-frozen-shoulder

    For more info visit

    https://www.physio-pedia.com/Adhesive_Capsulitis

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