What will be the management for Pain ?

62 year old female patients complaining of pain in shoulder since a month. Chief Complaints Unable to do household chores due to pain , pain in shoulder 24*7, more in Night History H/o fall on shoulder 1 month ago, Type 2 DM Physical Examination ACTIVE ROM OF( LEFT ) SHOULDER - FLEXION -110, EXTENSION -40 ABDUCTION -175 INTERNATIONAL ROTATION-85 EXTERNAL ROTATION -85 Passive ROM- full ROM of all actions MMT- GRADE 4 IN ABDUCTION AND FLEXION GRADE 4 IN ROTATION Right Shoulder - no isolated movements ( atrophy of all shoulder girdle muscle) since childhood ( H/o poliomyelitis ?) Investigations MRI - FULL Thickness tear of SUPRASPINATUS with early fatty infiltration Tear in Anterior margin of INFRASPINATOUS WITH fatty infiltration Grade1/2 partial thickness tear in SUBSCAPULARIS involving with articular surface No Atrophy Biceps Tendinosis Acromioclavicular joint Arthropathy with mild fluid in subacromial and subdeltoid bursitis Diagnosis Rotator cuff tear Management Not operated for tendon tear Conservative management with NSAID for 1 week

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62yr age with supraspinatus tear with fatty infiltration...conservative treatment and better to avoid surgery.

Laser physiotherapy treatment best option for you

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Hot fermentation therapy for 20 min Tens for 15 min Ultrasoundtherapy for 7 min

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For Rotatar cuff tear... advice to heat therapy,use tapping technique for SITS muscles....and advice medial and lateral glides for abduction and addiction. Maitland's / mulligan's techniques are advised.....if possible.....??!!!!!!!!

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Physiotherapy management will be helpful to reduce pain and suffering.

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@Dr. Pankaj Singhal (Pt) @Dr. Anton Job Romesh Prasad @Dr. Srivalli Jandyala (Pt)

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