Case Study Shoulder OA

• • Sarah - 55 year old woman with a 12-month history of right shoulder pain and stiffness
  • She is quite stubborn and thought it would go away on its own
  • She is frustrated with her lack of progress and decided to try physiotherapy
  • She reports that her symptoms have been gradually improving over the past 3 months, but she still experiences some limitations in her daily activities
  • Sarah is a retired librarian who enjoys gardening and playing with her grandchildren
  • She has a history of type 2 diabetes, which is well managed with medication
  • She is right handed
• Differential Diagnosis:

  • Rotator cuff related shoulder pain
  • Subacromial Bursitis
  • Adhesive Capsulitis (Frozen Shoulder)
  • Glenohumeral Osteoarthritis
  • Scapulothoracic Dysfunction
  • Cervical Radiculopathy
  • Thoracic Outlet Syndrome
  • Proximal diabetic neuropathy (Diabetic Amyotrophy)
• Other Subjective Questions:

  • tried other therapies or surgeries for your shoulder pain?
  • describe the location and radiation of your pain?
  • any night pain or pain at rest?
  • any weakness or fatigue in your arm or shoulder?
  • specific examples of activities that cause you discomfort?
  • any neck pain? Any numbness / tingling?
  • any recent trauma or repetitive strain to your shoulder? (Ask to describe in further detail)
• Subjective:

  • Chief Complaint: 12 month history of right shoulder pain and stiffness which has been gradually improving over the past 3 months
  • History of Presenting Complaint: symptoms began suddenly without any specific trauma, reports her shoulder "just started to ache" and gradually became stiffer
  • Aggs: reaching overhead, lifting and sleeping on her right side
  • Eases: heat, gentle exercises, avoiding heavy lifting
  • PMH: type 2 diabetes, well managed with medication
  • Social History: retired librarian, enjoys gardening and playing with her grandchildren
• Objective:

  • observation: slight scapular winging on right side, more pronounced when attempts to lift arm
  • posture: generally good, but tends to lean way from affected side
  • ROM
  • Forward Flexion: 120 ° (limited by pain and stiffness)
  • Abduction: 90 ° (limited by pain and stiffness)
  • ER: 30 ° (limited by pain and stiffness)
  • IR: 40 ° (limited by pain and stiffness)
  • muscle strength: 4/5 in right shoulder muscles, some weakness in rotator cuff muscles
  • special tests:
  • Shoulder Shrug Sign: Positive
  • Hand to Neck Test: Limited by pain & stiffness
  • Hand to Scapula Test: Limited by pain & stiffness
• Assessment:

  • diagnosis: frozen shoulder, in the thawing phase
  • stage: thawing phase, characterised by gradual improvement in ROM and reduction in pain
  • contributing factors: diabetes, possible rotator cuff weakness
• Plan:

  • short term:
  • improve ROM in right shoulder
  • reduce pain and stiffness
  • improve strength in rotator cuff muscles
  • long term:
  • return to full function and activity level
  • prevent recurrence of symptoms
  • interventions:
  • gentle exercise to improve ROM and strength
  • heat and cold therapy to reduce pain and stiffness
  • education on proper posture and body mechanics
  • progression to more advances exercises and activities as symptoms allow
• Plan:

  • implementation:
  • plan will be implemented over the next 6 to 8 weeks, with regular progress assessments and adjustments to the plan as needed
  • sarah will be educated on the importance of consistent exercise and self-management strategies to prevent recurrence of exercises
  • evaluation:
  • regular evaluations will be conducted to assess progress and adjust the plan as needed
  • outcome measures will include range of motion, pain levels and functional stability
• Plan - outcomes to consider pt 1:

  • Shoulder Pain And Disability Index (SPADI) - self report questionnaire that assesses shoulder pain and disability, consists of 13 items that evaluate pain, disability and function
  • Disability of Arm, Shoulder and Hand (DASH) - self report questionnaire that assesses upper limb function and disability, consists of 30 items that evaluate physical functions, symptoms and social and emotional function
• Plan - outcomes to consider pt2:

  • Quick DASH - short version of DASH, consists of 11 items that evaluate upper limb function and disability
  • Patient-Specific Functional Scale (PSFS) - self report questionnaire that asses pts ability to perform specific functional activities that are important to them. It can be used to evaluate progress in achieving functional goals