Shoulder Pain

What treatment will you give to correct scapulo humeral rhythem and painful arc movement? Chief Complaints 50 y/o female of shoulder pain came with c/f not moving arm in tuning the way it should History In past history she had visited physiotherapist and got treatment of frozen shoulder Physical Examination patient has scapulo humeral rhythem and also painful arc movement in mid range. Affected ranges are written here Shoulder flex : 0 - 100 degree (active) Sh. Abd : 0- 90 degree ( active) Endfeel : Empty(due to pain patient didn't let it check)




Frozen shoulder - it is due to capsulities and Painful arc - it is due impinge of the tendon against acromion . Both symptoms include over head actions restriction and abduction range Rule out wheather it is frozen or painful arc . Management include maintaining the traction of the segment which reduce impingement ( position ) pain management - US Home advices - should not sleep on effected side , prevent pain causing activities , rest ..after reduction of pain strengthing excercises are advised

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It seems like Supraspinatus tendon impingement.. give local ultrasound application to the tendon... Work for ranges of external rotation of humerus before you try to get overhead abduction or flexion. Gentle glides to scapula and also to acromioclavicular joint... Sling for support during heavy activities/ travelling can be considered.. functional arm slings are available ..

How will you differenciate between impingement and tendinitis of muscle? @Dr. Melitta Menezes (Pt)

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If the active and passive shoulder roms are affected in abduction n flexion then adhesive capsulitis is the case n capsule is affected. Painful arc is when the active ranges are full but there is pain in mid range- rc tendons are affected. US for shoulder pain. Work on shoulder ranges with pulleys, GH scapular glides and external rotation to achieve the remaining abduction range. check for scapular stabilizers like middle trapz n sa, work on them first n then on the rotator cuff muscles.

How will you do differntiate diagnosis? According to new research pulley is prohibited as it increases arthritis problems. Is it your opinion still to give pulley and why?

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Maybe it's tendon impingement , Restricted the overhead activities for some time Gently release supraspinatus m/s & Ultrasonic therapy for pain reduction Shoulder mobilization

How will you do differenciatial diagnosis? @Dr. Vijay Mudgal (Pt)

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