Adhesions Injury Case Study

S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2-3/10. TM denies any loss of ROM or sensation of the right arm; denies any tingling or numbness.

Komblatt, the patient underwent extensive chiropractic treatment with 87 sessions from 10/07/11 through 07/11/12. It was opined that it does appear that the IW ha s undergone excessive passive-chiropractic treatment referable to both lumbar spine and right shoulder. It was further opined that the IW has reached MMI regarding the lumbosacral strain and contusion of the right shoulder within approximately 6-8 weeks post injury. Appropriate treatment would have consisted of aggressive right shoulder and low back rehabilitation to include aerobic conditioning, strengthening exercises involving the right upper extremity, lumbar spine and core, and resumption of normal recreational and work activities within 6-8

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

The difficult combination of adhesive capsulitis and a torn rotator cuff in a patient with blood sugars that however around the 200s, was discussed. He understands that he is an increased risk of multiple complications and his therapy will likely take longer due to the inevitable stiffness that will occur. He would like to proceed.

DIAGNOSIS: Impingement syndrome, right shoulder; full-thickness rotator cuff tear with retraction, right shoulder; adhesive capsulites, right shoulder; post-op pain, right shoulder; Right elbow strain/sprain; Right wrist strain/sprain; Right upper extremity overuse syndrome.

Painful arc syndrome (rotator cuff tendinitis, tear or impingement syndrome): Painful arc syndrome is a condition characterized by pain in part of the ROM, between 45 and 160 degrees. Bicipital tendon rupture: Bicipital tendon rupture is frequently diagnosed in association with rotator cuff disease as a component of the impingement syndrome. Glenohumeral adhesive capsulitis (frozen shoulder or pericapsulitis): Adhesive capsulitis is a condition of uncertain etiology characterized by progressive soft tissue restriction of both active and passive shoulder motion (Huang, et al. 2012 and Brauer et al. 2013).

Based on progress report dated 03/09/15, the patient reported of persistent left shoulder pain. She has attended at least 12 PT sessions with non resolution of her symptoms. Due to left shoulder pain with positive impingement test despite 7 weeks of conservative care with NSAIDS, muscle relaxant and PT, left shoulder MRI for further evaluation is recommended. PT for 3 times a week for 4 weeks is also requested. She was advised to continue Anaprox and Flexeril.

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Rotator cuff tendons are prone to degeneration leading to swelling with sub-luxation due to continuous active and passive forces. Rotator cuff pathology includes tendinopathy, tendinosis and bursitis, as well as rotator cuff tears. Most common indication for rotator cuff tears include increasing age and traumatic shoulder injury. Clinical symptoms for rotator cuff injuries include shoulder pain, weakness and loss of range of motion. However, these symptoms are common in various diseases; differential diagnosis includes labral tears, glenohumeral ligament tears or sprains, coracoacromial and arcomioclavicular ligament tears and sprains, osteoarthritis, adhesive capsulitis, proximal peripheral neuropathies and cervical radiculopathy. Hence,

Impingement syndrome: As indicated by Shahabpour, Kichouh, Laridon, Gielen, & De Mey (2008, p. 194), magnetic resonance imaging is the imaging tool of choice for evaluation of articular structure and soft tissue of the shoulder; it can aid in the detection of soft tissue anomalies linked to shoulder impingement. Similarly, Wise et al. (2011, p. 605) acknowledge the importance of MRI as an instrument in identifying osseous and soft tissue irregularities that may lead to or be the consequence of shoulder impingement.

AC, is a painful and debilitating condition affecting 2% - 10% of the population (Neviaser and Hannafin, 2010: Cadogan and Mohammed, 2016). Statistical data indicates a higher prevalence in women (59% - 70%), a mean onset age of 50 - 60 years (Cadogan and Mohammed, 2016). The average condition duration presents for 30.1 months but ranges from 1 - 3.5 years (Hand et al, 2008) placing a considerable burden upon individuals and health care services. The non-dominant arm is slightly more affected then the dominant arm (Hand, Clipsham, Rees and Carr, 2008: Levine, Kashyap, Bak, Ahmad, Blaine, and Bigliani, 2007) and the risk of recurrence on the contralateral side within 5 years of the first occurrence is 6%–17%, recurrence in the

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

DOI: 09/06/2013. This is a case of a 57-year-old female biometric technician who sustained a work-related injury to her right shoulder when she grabbed an elderly gentleman with her right arm to prevent him from falling or hitting his head. As per OMNI entry, patient was diagnosed with shoulder strain. Per progress report dated 4/26/2016, patient presents for follow up evaluation and continues to complain of constant right shoulder pain over the acromioclavicular joint. Patient had two intra-articular steroid injections that provided significant relief. She is requesting for an additional shot at the time of visit. She rates her pain at 7/10 on a pain scale. Patient reports that Norco relieves the pain at 4/10 for 3-4 hours with received therapy

The following literature review describes the pathophysiology, epidemiology, associated comorbidities, secondary conditions and treatment of adhesive Capsulitis (Frozen Shoulder) with an emphasis on current physical activity and exercise as a treatment strategy.

There is a gap existing in literature which has failed to provide sufficient, high quality evidence favouring one treatment intervention over other in treating subjects with shoulder dysfunction conservatively. The variance that exists among clinicans regarding treatment