Observation Of The Client, The Head

On examination, cervical and lumbar spine is restricted in all planes with increased pain. Muscle guarding is also noted. The patient is not able to heel and toe walk. He is obese and deconditioned. Straight leg raise (SLR) is positive bilaterally. Muscle guarding is noted along cervical paraspinal and trapezius muscle groups bilaterally. Sensation is normal to light touch, pinprick, and temperature along all dermatomes of the bilateral upper extremities, except right C6-8, decreased to

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

She reports tenderness to the posterior aspect of the cervical spine, trapezius region and scapular region with deep palpation.

Scharf utilized Diagnosis Related Estimate cervical category II and assigned an 8% Whole Person Impairment. Dr. Scharf noted the MRI study of the cervical spine right disc extrusion at C5-C6, but there are no verifiable radicular symptoms in light of the result of the EMG/NCV studies, despite the applicant’s subjective complaints of radicular symptoms into the bilateral upper extremities. Since there are no verifiable radicular symptoms, the placement into DRE category II seems appropriate.

O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

Carey reported that she experienced occasional numbness of the upper extremities and that she would occasionally drop objects from both hands. Upon physical examination, Dr. Abiera noted that Ms. Carey’s range of motion of the cervical spine was decreased on flexion and tenderness on palpation of posterior cervical muscles with spasms and trigger points was present. In addition, Dr. Abiera noted that the range of motion of lumbar spine was within normal range, however there was still some tenderness on palpation of thoracic paraspinals muscles.

The patient was compliant to all aspects of treatment and the home exercise program. There are no known alternate explanations of the outcomes of this case report. However, in comparison to the case report by Caldwell et al25., the patient in this case report displayed a faster decrease in pain and return to normal function indicated by 0/10 VAS, 0% neck disability and ability to perform all tasks for work at the last day of treatment, 3 weeks from the first day of physical therapy. Possible explanations for the faster recovery could be due to the slight difference of impairments as well as the addition to grade IV and V manipulations to the cervical and thoracic spine as suggested to have high correlation with decrease in pain and normalization

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.

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

Electrodiagnostic consultation report dated 10/02/15 revealed normal study of both upper limbs and cervical paraspinals. No evidence of cervical radiculopathy. No median or ulnar neuropathy.

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

Mcclurg, the patient presents for his neck pain, described as dull and aching. Treatment to date includes activity modification, acupuncture, and 9 sessions of chiropractic care. Condition is improving. Current care has provided 70% pain relief. Of note, MRI of the cervical spine dated 3/25/2015 revealed C5-6 discogenic spondyloarthropathy with mild central canal stenosis and mild bilateral C4-5 facet arthrosis.

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

On both shoulder the athlete have a space of 6cm, the athlete scored a 2 as the fists ae within one and a half hand lengths of each other. But as the athlete recorded pain in the right shoulder while doing the Shoulder Mobility and in the Active Scapular Stability test below she now gets scored as a score of 0 due to pain.

Shacklock, M. O. (1996). Positive upper limb tension test in a case of surgically proven neuropathy: analysis and validity. Manual Therapy, 1(3), 154-161.