Case Study Rotator Cuf Injury
Initial Evaluation - 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)
Diagnosis
(R) supraspinatus tendonitis
Symptoms - 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
Observation
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
Function - 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
Prioritise problems
1. Pain
2. ROM
3. Flexibility
4. Strength
Additional issues - Mild Hypertension - Increasing stress and anxiety levels - Home environment – disabled husband and children no longer at home
Supplemental Information - No palpitations or special testing was conducted; as this injury is deemed chronic and it was felt further testing was not necessary
Long-term goals
1. Return to work (12 weeks) performing modified or full range of tasks with
Diagnosis
(R) supraspinatus tendonitis
Symptoms - 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
Observation
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
Function - 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
Prioritise problems
1. Pain
2. ROM
3. Flexibility
4. Strength
Additional issues - Mild Hypertension - Increasing stress and anxiety levels - Home environment – disabled husband and children no longer at home
Supplemental Information - No palpitations or special testing was conducted; as this injury is deemed chronic and it was felt further testing was not necessary
Long-term goals
1. Return to work (12 weeks) performing modified or full range of tasks with
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.