- Ultrasound indicated inflammation and thickening of (R) supraspinatus tendon, subacromial bursitis and anterior acromion spurring - Chronic neck, shoulder and wrist pains suffered from work activities. Afraid to act in case of workplace ramifications - Mild hypertension (currently managed through dietary intervention)
(R) supraspinatus tendonitis
- Constant (R) anterior shoulder, upper cervical and thoracic pain (VAS 5/10). VAS increases to 8/10 with overhead reaching and shoulder abduction. - Relief from symptoms with rest, heat packs and medication
Mechanism of injury
- Process line worker conducting repeated upper limb tasks
- Heavy (10kg) overhead lifting, repetitive transfer of 5-7kg boxes from waist to floor level for up to 2hr intervals, screwing bottle lids, quality control assessment and packing boxes. - Possible aggravation during household tasks i.e. cleaning, cooking and washing
Anxious about using (R) shoulder and protective against further injury
Psychological & Pain Testing
- OMPQ score of 120
- DASS questionnaire: depression=5, anxiety=13, stress=20
- Limited ROM during abduction and overhead reaching
- Reluctant to use right shoulder unless necessary
List of problems
- Pain in (R) Shoulder, cervical and thoracic regions
- Decreased (R) shoulder ROM (abduction, overhead movement) - Decreased (R) shoulder flexibility
- Decreased strength in (R) shoulder
- Mild Hypertension
- Increasing stress and anxiety levels
- Home environment – disabled husband and children no longer at home
- No palpitations or special testing was conducted; as this injury is deemed chronic and it was felt further testing was not necessary
1. Return to work (12 weeks) performing modified or full range of tasks with minimal pain 2. Return to full ROM in 6 weeks
3. Regain full strength in 12 weeks
1. Reduce constant pain to 2/10 at rest 2-4 weeks; reduce active pain to 4/10 4-6 weeks 2. Increase abduction to 180o in 6 weeks
3. Introduce closed chain kinetic exercises in 4 weeks
Treatment/RTW/Activity plan (2-3 days/wk in clinic + home program)
Stretches and ROM exercises will commence as passive motion whilst pain remains present, and progress to active motion as the client becomes stronger and regains free movement of the injured shoulder. Exercises will initially be performed with no resistance and with a high degree of caution. As rehabilitation progresses, theraband and wands will be utilized to increase muscle stability, function and strength:
Internal and external rotation
Flexion below 90o and extension
Abduction below 90o and adduction
Passive neck stretches (flex/ext, rotation)
Shoulder flexion with pulley for passive stretch
Strengthening exercises will develop when appropriate to include a power component:
Protraction/Retraction of scapula
Internal and external rotation
Flexion and extension in sagittal plane
Four point kneel
Swiss ball exercises (i.e. pelvic circles & leg raises)
Lateral raises w/ dumbbell (progress to sitting on Swiss ball)
Standing row w/ theraband (progress to sitting on Swiss ball)
Cardiovascular maintenance will also be included in rehabilitation to improve overall physical fitness levels. At each session the client will perform up to 30 mins of moderate intensity walking, increasing the time and frequency of these walks as the program progresses.
Specific interventions by week or post-injury phase / Theory and Evidence of Effectiveness:
The program provided in this case study is based upon a logical progression through rehabilitation phases, each setting the groundwork for the phase to follow. This...
References: 1. Fongemie, A.E., Buss, D.D., & Rolnick, S.J. (1998). Management of shoulder impingement syndrome and rotator cuff tears. American Family Physician. 57(4), 667.
2. Kibler, B.W. (1998). Shoulder rehabilitation: principles and practice. Medicine and Science in Sport and Exercise. 30(4), 40-50.
3. Lyons, P.M., & Orwin, J.F. (1998). Rotator cuff tendinopathy and subacromial
impingement syndrome. Medicine and Science in Sport and Exercise. 30(4), 12-17.
4. O’Connor, F.G., Howard, T.M., Fieseler, C.M. & Nirschl, R.P. (1997). Managing Overuse Injuries : A Systematic Approach. The Physician and Sports Medicine. 25 (5) 88-113.
5. Stark, T.W. (2006). Introduction of a pyramid guiding process for general musculoskeletal physical rehabilitation. Chiropractic & Osteopathy. 14 (9) Online Edition.
Please join StudyMode to read the full document