Physical Therapy Case Studies

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

On 4/25/17 I met Mr. Westenberg for his pr-operative teaching at the office of Dr. Cherwin. He was given a refill on his pain medication. He will be having blood work done on 4/26/17. Mr. Westenberg has been instructed on the use of the sling and what home exercises he needs to do after surgery. He asked about returning to work in 5 to 10 days. He was told that Dr. Cherwin will give him a work slip stating no use of the left arm. The post operative appointment will be 10 days after surgery. He will be given the date and time the day of his surgery.

Mr. Krupp had the repair to the torn bicep tendon on 6/30/17. He reported that he was given a cold compression device and that really helped with the pain. On 7/10/17 I met him at the MSU sport medicine clinic. We met with Dr. Supinanski. The sutures were removed to the left inner aspect of the arm. There are no signs of infection. Mr. Krupp said he has not taken any pain medications for days. Instructions are no lifting with the left hand of a pound or more. He will start physical therapy now. At the next appointment Dr. Scorfar will address the left shoulder. At this point, no repair to the left shoulder can be done, we need to let the bicep tendon heal

HISTORY OF PRESENT ILLNESS: Brandon is a right hand dominant trailer manufacture worker who has been off work since his injury, who injured his right dominant hand seven weeks ago when he caught it between a heavy TV set he was carrying at home and the wall, sustaining a painful deformity of the right hand. That treatment consisted of a closed reduction of the fourth and fifth metacarpal bases done by Jake Heiney, MD. The patient had a benign post-operative course and was recovering uneventfully. His records were reviewed for this visit. He reports no complaints of pain or swelling. No neurovascular or muscular changes. He feels much better overall. No pain at all with most activity. Occasionally sore when he has used it a lot.

DOI: 5/1/2015. Patient is a 57-year old male certified nursing assistant who sustained injury to her left shoulder due to rendering overtime almost everyday. Per OMNI, he was initially diagnosed with left shoulder sprain.

Based on the progress report dated 08/22/16, the patient presents for re-evaluation 1 year status post right shoulder surgery. The patient had a right shoulder cortisone injection administered on 6/6/16. The patient reports she is doing no better than at her last visit. She experiences constant pain with certain movements. Though her pain is persistent, it is not severe. She also experiences a burning sensation over the anterior shoulder. She does not perform her exercises regularly, but is able to do push-ups. Pain is rated as

PLAN: Outpatient physical therapy to work on strengthening of the left shoulder and rotator cuff. The patient has decreased function at this time and moderate pain, physical therapy will help him to regain and as well preserve his function, and he will follow up with us in 4 weeks. Furthermore, patient will be receiving glucocorticoid inject to minimize associated

Per Dr. Williams, your MRI of the right elbow show partial tearing of a tendon at its attachment to the bone. He have placed a consult to ortho to further evaluate and treatment. CAMO should call you within the next 2-3 business days to assist you with scheduling an ortho appt. However, if they do not call within three business days please call them at 916-9900 to assist with scheduling appt.

On April 28th, I endured my first shoulder and elbow evaluation. After going through the evaluation process and discussing my diagnosis of biceps tendonitis to my preceptor, we then took the athlete up to Burke Physical Therapy for some modality treatments. Before I started treatments, I asked Tim, the owner of Burke and a physical therapist himself, if I could present my evaluation procedure and findings to him. He was not busy and enjoys helping us students out, so he gave me some of his time. I first started off with explaining to Tim who this athlete was. He is a javelin thrower who has been experiencing pain in the anterior part of his shoulder and on the anterior part of the elbow. His pain started a few weeks ago but ice seemed to help, until this week at practice,

01/12/16 Progress Report documented that the patient has persistent pain in the ulnar left arm and forearm, which radiates into the ulnar hand, ring, and small fingers. It was noted that the MRI performed on 02/15 was of the left WRIST. The left elbow, arm, and forearm have not been imaged. The nerve conductions study was consistent with persistent and worsening ulnar compression neuropathy, possibly secondary to compression at flexor fascia of proximal forearm and intermuscular septum of medial arm; following attempted

Spencer’s case are insufficient to make an informed decision at this time. I would first like a more clearly defined timeline and ability for the progression of the muscle wasting in his dominate arm. Furthermore, I would like a further delve into the location of the muscle lesion that is causing the paralysis. No information was given regarding the muscles innervated by the long thoracic, dorsal scapular, nerve to subclavian, upper subscapular of lower subscapular. If a nerve transfer could be performed to bypass the major issues that are facing him, it would be to his benefit. However, since the injury was 3 years ago we are outside the maximum 24 months to perform a nerve transfer due to the immediate irreversible damage that is done to the motor end plate immediate following denervation. However, since this is a partial paralysis, I would like to have a better understanding of the current state of the damage. Since the gracillis transfer is such an invasive surgery if we could lessen the comorbidities it would be in the patient’s

The patient has completed a total of 24 sessions of physical therapy on 09/08/15. He demonstrated significant gain in his range of motion and strength. He continued to have minimal pain at bicep regions secondary to torn bicep tendon. The patient was being discharged as the patient met the long term goals.

On 3/2/ 17 I met Mr. Kraxner for a follow up appointment with Dr. Morse. Mr. Kraxner is able to actively raise his right arm to just above the shoulder level; passively he has full range of motion. The muscle is weak. He gives great effort while in physical therapy along with a home exercise program. He reports he take 600mg Motrin 3 times per day, and use the cold compression device along with the TENS unit to help with pain. He is sleeping in a bed. Dr. Morse reminds him that he had a very large tear, that 2 of the four muscles were torn away. This is going to make his recovery process slower. Dr. Morse was happy with his progress. He said it would take a full year of healing to regain full strength. Physical therapy will continue.

During my experience, the clinic was not very busy therefore, I only had the opportunity to observe one patient being treated. The patient was a retired male in his fifties returning for a treatment session. The DPT3 student explained the pt was diagnosed with tennis elbow or lateral epicondylitis most likely due to his follow through swing when playing golf. The patient stated he had played in a golf tournament since his last treatment but utilized a homemade brace to help with discomfort. The patient explained he was able to finish the tournament but was experiencing a great amount of pain during and after. The therapist then asked the pt what his level of pain was before starting treatment, then preceded to preform mobilizations including: radial-ulnar anterior and posterior glides both proximally and distally.1 This coincides directly with what we have learned in class to do for a treatment intervention. Following manual therapy by the PT, the