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Mind Map

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by

K Weems

on 22 June 2014

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Transcript of Mind Map

Subjective
Objective
Assessment
Plan of Care
Systems Review
Tests and Measures:
First Session
Musculoskeletal
46 y.o female
Wife, mother of 2
Left handed
Professor at
Walsh University

Social/health habits
Does not smoke
Drinks alcohol socially
Medical hx
S-curve scoliosis
Thyroid cancer, removed
Abnormal heart beat, PVC
Family health hx
Father: 3 types of cancer
Mother: heart disease, RA, scoliosis, MI
R shoulder pain
2/10 VAS currently
7/10 VAS at worst
2/10 VAS at best
Pain with overhead reaching, sleeping with arm overhead, and using laptop
R shoulder weakness
Onset: January 2014
Current Condition
Patient History
Patient Goals
Prior level of function
Able to perform all ADLs without pain
Functional Status
Works out regularly
No longer able to do circuit training
Wants to decrease pain during:
Lifting purse/briefcase
Circuit training
Reaching overhead
Computer use
Cardiovascular/Pulmonary
BP: 110/70
HR: 68 bpm
RR: 12 breaths/min
Gross symmetry impaired
Gross R shoulder ROM impaired
Gross R shoulder strength impaired
Unimpaired
Integumentary
Neuromuscular
Communication
R shoulder abduction
WNL
Pain 60-120 degrees
R shoulder flexion
WNL
Pain during movement
R shoulder horizontal adduction
WNL
Pain during movement
R shoulder external rotation
0-34 degrees (L shoulder: 0-99 degrees)
Pain at 31 degrees
L shoulder
All motions WNL
No pain
Range of Motion
Manual Muscle Testing
Special Tests
R shoulder strength
Low trapezius: 3+/5
Mid trapezius: 3+/5
External rotation: 3+/5
Internal rotation: 3+/5
Positives
Supraspinatus Test
Hornblower's Sign
Cross-body Adduction Test
Painful Arc Test
Infraspinatus Test
Negatives
Lift-off Test
Neer Test
Drop Arm Test
AC Palpation
Evaluation
Diagnosis
Prognosis
Limited R shoulder external rotation ROM and pain
Prevents pt. from performing ADLs
Pain during active R shoulder flexion and abduction
Prevents pt. from reaching overhead
Differential Dx #1
Differential Dx #2
AC Joint Pathology
Cervical Radiculopathy
MOI
Special Tests
Negative AC joint palpation
No pain end range R shoulder abduction
Differential Dx #3
Cervical ROM
Repetitions and overpressure
No neurological symptoms
Impingement/Rotator Cuff Tear
ROM
Limited external rotation
MMT
Low trapezius
Mid trapezius
Internal/External rotators
Special Tests
+Infraspinatus Test
+Supraspinatus Test
+Hornblower's Sign
+Painful Arc Test
+Cross-body Adduction
+Apley's Scratch Test
Palpation
Tenderness of the supraspinatus tendon
Good rehab potential
Eager to learn
Compliant
Should be able to reduce pain and increase ROM
Treatment
Patient Education
Re-evaluation
Classification
Dysfunction
Red flags
Viscerogenic
Change in pain with change in position
Increased pain with motion
Vasculogenic
Pain does not increase with activity
No sharp pain
Spondylogenic
No systemic symptoms
No pain at night that wakes her up
Neurogenic
No numbness, tingling
No radiating of symptoms
Psychogenic
No hx of depression/anxiety
Minimal stress
Pt. > 30
Pain is central in location
Insidious onset with acute initiation
Decreased AROM
No peripheralization
Pain not worsened with activity
Home Exercise Program
In-session
Augmented R shoulder external rotation with cane
Augmented R shoulder abduction with cane
Passive R shoulder horizontal adduction
First Session
Second Session
Isometric strengthening with Theraband
External/Internal Rotation
Augmented superior to inferior mobilizations with towel
Proper posture during shoulder abduction using mirror
Passive physiological R shoulder abduction mobilization
Passive accessory R shoulder superior to inferior mobilization with passive abduction
Passive physiological R shoulder external rotation mobilization
Passive accessory R shoulder AP mobilization
Passive accessory R shoulder AP mobilization with active external rotation
Proper carrying technique of purse/briefcase
Management of purse/briefcase weight
ROM
MMT
Pain/VAS score
PT Goals
Decrease pain
Overhead motions
Operating computer/mouse
Lifting briefcase
Increase ROM
External Rotation
Increase strength
External Rotation
Internal Rotation
Full transcript