Quickdash Achieve Report

The ratings for this scale vary from no pain, a zero, to the worst pain one could possibly endure, a ten ('Misha' Backonja & Farrar, 2015).  This type of tool used for measuring pain is considered a self-assessment.  Meaning, the individual rates his/her pain on the provided scale.  All individuals who have received medical treatment, whether for a serious injury or a yearly physical, has been asked, “What would you rate your pain today, on a scale of one to ten?”.  This pain assessment tool is considered a fully ordered variable due to the individual having a wide range to rate his/her

Range of motion shows flexion of 85 degrees, extension of 30 degrees, and lateral tilt of 25 degrees bilaterally. Straight leg raise is positive on the right at 90 degrees for low back pain. Bechterew's test is positive on the right. The patient has diminished sensation in the right L4, L5 and S1 dermatomes. Deep tendon reflexes are absent in the right knee and right ankle.

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Dynamic scapular dyskinesis is detected by asking the patient to raise and/or abduct both arms repeatedly in a rhythmic motion, until fatigue of the scapular stabilizers results in failure to keep the scapula well positioned in relation to the thoracic wall. Active scapular retraction and elevation are checked. The next step is to look for muscle atrophy and remember active and passive range of motion should be examined and compared with the non-injured shoulder. It is easy to detect muscle atrophy of the infraspinatus viewing from the back of the patient, whereas the supraspinatus is covered by the trapezius. Atrophy of the shoulder muscles is a common finding in patients with rotator cuff tears.

On examination of the right shoulder, there is pain on range of motion. Abduction was 160 degrees. Forward flexion was 165 degrees.

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

Manual muscle testing of the left glenohumeral joint with flexion, abduction and external rotation is 4/5. Patient is with limited use of the left upper extremity and has slow progress noted with precautions of pacemaker limiting aggressive stretching. Plan is to progress with ROM and mobility strength.

Validity: Overall the study is valid but limited as the study examined individual patients as a single case making the ability to generalize limited. The foremost dilemma with the study is the challenge in determining the difference in scores that correspond directly to a clinically important modification. The ability of the VAS to detect significant changes relies heavily on an established baseline as a standard to compare future data. Throughout the duration of the study, patients were asked frequently to complete the VAS and RMQ, this may possibly lead to learning effects which may impact the results of the pain and functional status

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

Even with active assistance, the patient can only achieve approximately 140 degrees of forward elevation, 60 degrees of external rotation, and internal rotation barely to his upper sacrurn. He has 4/5 supraspinatus weakness and pain. Internal and external rotation strength seems to be normal. He has a nonspecifically painful Neer’s, Hawkins, and O’Brien’s test. His proximal biceps and acromioclavicular (AC) joint are both very tender to palpation.

*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.

All research shows that all tests conducted and possible differences within each test still lead to similar conclusions. With two different studies that both utilized electromyography as the primary distinction of the activation of the supraspinatus during the empty can test, this can give physical therapists and patients confidence that the validity of the test is tremendously accurate. All of the electromygraphy results deemed the supraspinatus strongly isolated during this test which is a sturdy indication that the test is valid. The third study shown is best in demonstrating the reliability of the empty can test. With the results being so similar in the two clinicians testing, this shows the test to be reliable. This test could have been made even more accurate had there been more clinicians to perform the test with their results compared to each

For shoulder flexion 61% of the variance could be accounted for by the sit-and-reach. A correlation was also found between the modified sit-and-reach test and both the shoulder extension and hip flexion tests. For shoulder extension 33% of the variance was accounted for by the modified sit-and-reach and for hip flexion 22% of the variance was accounted for by the modified sit-and-reach.

This case study is about a twenty-six year old graphic designer. Who is an amateur rugby player, who trains twice a week for two hours and has games once per week. In terms of previous injury they fractured their left ankle three years ago. The main problem of the client is left-sided neck pain and restriction of range of movement (ROM). The cause was a tackle during a match which resulted in heavily landing on left shoulder they played on but, it gradually stiffened during the match. On observation the client has a poking chin, increased thoracic kyphosis and an elevated left shoulder, also on touch of the left shoulder the upper trapezius is tight. Aggravation of the injury

Pain cannot be measured by anyone other than the patient that is having the experience. This is why pain is sometime not understood and misevaluated by healthcare workers. Pain is measured by the Visual analog scale (VAS) of 1-10. One being the least amount of pain and ten being the worst possible. This test is done every four hours and reviewed 30 minutes after a medication administration for pain control. This non-invasive test gives the healthcare worker a measurable idea of the intensity of the pain the patient is experiencing. This also gives the health care worker a perceptive of how well the patient responds to pain after medication administration. Pain is not always seen it can be an eternal feeling.