I am Physiotherapist

12/12/2024

Differential Diagnosis of Shoulder Pain

1️⃣ Musculoskeletal Causes

🔸Rotator Cuff Disorders
Tendinopathy/Tendinitis: Pain during overhead activities, localized to the lateral shoulder.
Rotator Cuff Tear: Weakness during abduction and external rotation, positive Empty Can Test and Drop Arm Test.

🔸Subacromial Impingement Syndrome: Painful arc during 60°-120° abduction, positive Neer’s Test and Hawkins-Kennedy Test.

🔸 Frozen Shoulder (Adhesive Capsulitis)
Progressive loss of active and passive range of motion, particularly external rotation.
Pain initially, followed by stiffness.

🔸 Acromioclavicular (AC) Joint Pathology
Localized pain at the AC joint, aggravated by cross-body adduction.
Positive Cross-body Adduction Test.

🔸 Labral Tears
Often from trauma or overuse (e.g., throwing athletes).
Clicking or locking sensation, positive O’Brien Test or Apprehension Test.

🔸 Shoulder Instability
History of dislocation or subluxation.
Positive Apprehension and Relocation Test for anterior instability.

2️⃣ Neurological Causes

🔸 Cervical Radiculopathy
Referred pain from cervical spine (C5-C6 commonly).
Pain radiates to shoulder and arm, with sensory or motor deficits in a dermatomal pattern.
Positive Spurling’s Test.

🔸 Brachial Plexus Injury
Weakness and sensory changes following trauma.
Common in contact sports or accidents.

🔸 Suprascapular Nerve Entrapment
Weakness in external rotation, deep shoulder pain.
Common in overhead athletes.

3️⃣ Inflammatory or Rheumatologic Causes

🔸 Rheumatoid Arthritis
Bilateral shoulder pain, morning stiffness, and systemic symptoms like fatigue.
Swelling or warmth in the joint.

🔸 Polymyalgia Rheumatica
Pain and stiffness in the shoulder girdle, often in older adults.
Elevated ESR/CRP.

4️⃣ Traumatic Causes

🔸 Fractures
Clavicle Fracture: Pain, deformity, or swelling over the clavicle.
Proximal Humerus Fracture: Pain, inability to move the shoulder, often following a fall.

🔸 Shoulder Dislocation
Anterior: Arm held in abduction and external rotation.
Posterior: Arm in adduction and internal rotation, often due to seizures or electric shock.

5️⃣ Systemic or Referred Pain

🔸 Cardiac Causes
Myocardial Ischemia: Left shoulder pain with exertion, associated with chest pain, nausea, or sweating.
Rule out with ECG and cardiac enzymes.

🔸 Gallbladder Disease (Referred Pain)
Right shoulder pain referred from diaphragmatic irritation (Kehr's sign).

🔸Pancoast Tumor
Shoulder pain, arm weakness, and Horner's syndrome (ptosis, miosis, anhidrosis).

🔸 Diaphragmatic Irritation
Caused by subphrenic abscess or liver pathology, radiating to the shoulder.

6️⃣ Infectious Causes

🔸Septic Arthritis: Acute pain, fever, swelling, and warmth.
Osteomyelitis: Chronic bone infection causing deep pain.

7️⃣ Vascular Causes

🔸Thoracic Outlet Syndrome: Compression of neurovascular structures, presenting as arm pain, numbness, and sometimes discoloration. Positive Roos Test or Adson’s Test.

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12/12/2024

🛑Differential Diagnosis of Elbow Pain🛑

1️⃣ Lateral Epicondylitis (Tennis Elbow):
Cause: Overuse of wrist extensors, especially Extensor Carpi Radialis Brevis (ECRB).
Symptoms: Pain over the lateral epicondyle, worsened by gripping or wrist extension.
Tests:
☀️Cozen’s test: Resisted wrist extension with the elbow flexed causes pain.
☀️Mill’s test: Passive wrist flexion with elbow extension causes pain.

2️⃣ Medial Epicondylitis (Golfer’s Elbow):
Cause: Overuse of wrist flexors and pronators.
Symptoms: Pain at the medial epicondyle, worsened by gripping or wrist flexion.
Tests:
☀️Reverse Mill’s test: Passive wrist extension with elbow extension elicits pain.
☀️Resisted wrist flexion and pronation worsen symptoms

3️⃣ Olecranon Bursitis:
Cause: Repeated trauma or prolonged pressure on the olecranon.
Symptoms: Swelling over the olecranon, warmth, and mild tenderness.
☀️Tests: Clinical inspection and palpation confirm localized swelling. Aspiration may rule out infection or gout.

4️⃣ Ulnar Collateral Ligament (UCL) Injury:
Cause: Overhead throwing or valgus stress.
Symptoms: Medial elbow pain and instability.
Tests:
☀️Valgus Stress Test: Pain or laxity with valgus force.
☀️Milking Maneuver: Reproduces pain with valgus stress at the elbow.

5️⃣ Radial Tunnel Syndrome:
Cause: Compression of the radial nerve in the radial tunnel.
Symptoms: Pain over the extensor muscle mass (not the lateral epicondyle), worsened by repetitive forearm movements.
Tests:
☀️Resisted Middle Finger Test: Pain with resisted extension of the middle finger.
☀️Tenderness over the radial tunnel (4-5 cm distal to the lateral epicondyle).

6️⃣ Cubital Tunnel Syndrome:
Cause: Compression of the ulnar nerve at the elbow.
Symptoms: Medial elbow pain, numbness, or tingling in the 4th and 5th fingers.
Tests:
☀️Tinel’s Sign: Tapping over the cubital tunnel elicits tingling.
☀️Elbow Flexion Test: Sustained elbow flexion reproduces symptoms.

7️⃣ Elbow Fractures (e.g., Radial Head Fracture):
Cause: Trauma (fall on an outstretched hand).
Symptoms: Severe pain, swelling, and inability to move the elbow.
Tests:
☀️Fat Pad Sign/X-ray: Indicates intra-articular fracture.
☀️Limited range of motion, particularly supination and pronation.

8️⃣ Osteoarthritis:
Cause: Degenerative changes in the elbow joint.
Symptoms: Stiffness, crepitus, and pain with activity.
Tests:
☀️X-rays show joint space narrowing and osteophytes.
☀️Decreased range of motion on examination

9️⃣ Rheumatoid Arthritis:
Cause: Autoimmune inflammatory arthritis.
Symptoms: Bilateral elbow pain, morning stiffness, and swelling.
Tests:
☀️Rheumatoid factor (RF) and anti-CCP antibodies.
☀️Palpable synovitis during clinical examination.

🔟 Biceps Tendon Rupture (Distal):
Cause: Sudden load on a flexed elbow.
Symptoms: Pain in the anterior elbow, swelling, and weakness in elbow flexion.
Tests:
☀️Hook Test: Inability to hook the distal biceps tendon.
☀️Visible "Popeye deformity" (proximal retraction of the biceps)

1️⃣1️⃣ Posterior Interosseous Nerve Syndrome (PIN):
Cause: Compression of the posterior interosseous nerve.
Symptoms: Weakness in finger and thumb extension; no sensory loss.
Tests:
☀️Pain with resisted supination.
☀️EMG/nerve conduction studies confirm diagnosis

1️⃣2️⃣ Gout/Pseudogout:
Cause: Uric acid crystal deposition (gout) or calcium pyrophosphate (pseudogout).
Symptoms: Sudden onset of severe elbow pain, swelling, and warmth.
Tests:
☀️Joint aspiration shows crystals (urate or calcium pyrophosphate).
☀️Elevated serum uric acid in gout

1️⃣3️⃣ Infection (Septic Arthritis):
Cause: Bacterial infection of the elbow joint.
Symptoms: Severe pain, redness, swelling, and systemic signs like fever.
Tests:
☀️Joint aspiration with culture confirms diagnosis.
☀️Elevated inflammatory markers (CRP, ESR).

1️⃣4️⃣ Little League Elbow (Medial Apophysitis):
Cause: Repetitive valgus stress in young athletes.
Symptoms: Pain over the medial elbow during or after throwing.
Tests:
☀️Tenderness over the medial epicondyle.
☀️X-rays may show widening of the growth plate.

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27/11/2024

Differential Diagnosis of Cervical/ Neck Pain

1. Mechanical/Non-specific Neck Pain

⭕Cervical Muscle Strain:
Caused by poor posture, overuse, or sudden movement.
Symptoms: Localized neck pain, stiffness, tenderness in affected muscles.
⭕Cervical Spondylosis (Osteoarthritis):
Degenerative changes in intervertebral discs and facet joints.
Symptoms: Gradual onset of pain, reduced range of motion (ROM), crepitus, may radiate to shoulders.
⭕Cervical Radiculopathy:
Compression of nerve roots due to herniated disc or osteophytes.
Symptoms: Pain radiating to arms, numbness, tingling, or weakness in affected dermatome.

2. Traumatic Causes

⭕Whiplash Injury:
Sudden hyperflexion or hyperextension of the neck.
Symptoms: Pain, stiffness, headache, and reduced ROM post-trauma.
⭕Fractures (e.g., C1-C2 or C7):
Commonly due to high-impact injuries.
Symptoms: Severe pain, restricted movement, neurological deficits if spinal cord involved.
⭕Ligamentous Injuries (e.g., alar ligament injury):
Instability and pain, often following trauma.

3. Inflammatory/Autoimmune Conditions

⭕Rheumatoid Arthritis:
Can involve cervical spine, particularly the atlantoaxial joint.
Symptoms: Chronic pain, morning stiffness, neurological signs if subluxation occurs.
⭕Ankylosing Spondylitis:
Affects sacroiliac joints first but may involve cervical spine.
Symptoms: Chronic neck pain, stiffness, and limited spinal mobility (bamboo spine).

4. Neurological Causes

⭕Cervical Myelopathy:
Compression of the spinal cord due to disc herniation, stenosis, or tumors.
Symptoms: Weakness, gait disturbance, loss of fine motor skills, hyperreflexia.
⭕Thoracic Outlet Syndrome:
Compression of brachial plexus or subclavian vessels.
Symptoms: Pain radiating to the upper limb, numbness, and weakness.

5. Referred Pain

⭕ Cardiac Causes (e.g., Myocardial Ischemia):
Symptoms: Pain radiating to the neck, jaw, or left arm, often associated with exertion.
⭕Gastrointestinal Causes (e.g., Esophageal Spasm):
Symptoms: Pain referred to the neck and chest, worsened by swallowing.
Diaphragmatic Irritation (e.g., Liver or Splenic Issues):
Can cause referred pain to the neck (Kehr’s sign).

6. Infectious Causes

⭕Meningitis:
Symptoms: Severe neck stiffness, fever, headache, photophobia, and altered mental status.
⭕Osteomyelitis or Discitis:
Infections of vertebral bones or discs.
Symptoms: Fever, localized tenderness, progressive neck pain.
⭕Abscess (e.g., Retropharyngeal or Epidural):
Symptoms: Fever, difficulty swallowing, neck stiffness, and neurological deficits if compressive.

7. Neoplastic Causes

⭕Primary Tumors (e.g., Multiple Myeloma, Osteosarcoma):
Rare but may cause localized neck pain, pathological fractures.
⭕Metastatic Disease:
Commonly from breast, lung, or prostate cancer.
Symptoms: Progressive pain, night pain, systemic symptoms like weight loss.
⭕Nerve Sheath Tumors:
May cause localized pain or neurological deficits.

8. Vascular Causes

⭕Cervical Artery Dissection:
Can lead to stroke.
Symptoms: Severe neck pain, headache, neurological signs.
⭕Vertebrobasilar Insufficiency:
Reduced blood flow in vertebral arteries.
Symptoms: Dizziness, ataxia, visual disturbances.

9. Other Causes

⭕Fibromyalgia:
Widespread musculoskeletal pain, tender points, fatigue.
⭕Temporomandibular Joint (TMJ) Disorders:
May present with referred pain to the neck.
⭕Psychogenic Pain:
Associated with stress, anxiety, or depression.

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10/03/2024

Drugs safe in pregnancy ✨
Be careful while giving any medications to a pregnant lady and must consult with a doctor..

©️ Credit: All credit goes to the original creator of this document (unknown)

27/02/2024

✍Medical terminology 👇

*1. Adeno* - Glandular
*2. An* - Not
*3. Anti* - Against
*4. Aorto* - Aorta
*5. Artho* - joint
*6. Bleph* - Eyelid
*7. Broncho* - Bronchi
*8. Cardio* - Heart
*9. Cephal* - Head
*10. Cerebro* - Brain
*11. Cervico* - Cervix
*12. Cholecysto* - Gall Bladder
*13. Coli* - Bowel
*14. Colpo* - Va**na
*15. Entero* - Intestine
*16. Gastro* - Stomach
*17. Glosso* - Tongue
*18. Haema* - Blood
*19. Hepa* - Liver
*20. Hystero* - Uterus
*21. Laryngo* - Larynx
*22. Leuco* - White
*23. Metro* - Uterus
*24. Myelo* - Spinal cord
*25. Myo* - Muscle
*26. Nephro* - Kidney
*27. Neuro* - Nerve
*28. Odonto* - Tooth
*29. Orchido* - Te**is
*30. Osteo* - Bone
*31. Oto* - Ear
*32. Pharyngo* - Pharynx
*33. Pio* - Pus
*34. Pneumo* - Lung
*35. Ren* - Kidney
*36. Rhin* - Nose
*37. Spleno* - Spleen
*38. Thyro* - Thyroid Gland
*39. Urethro* - Urethra
*40. Vesico* – Bladder

*Here are the suffixes used in Medical terminology. Check out!Suffix - Meaning

*1. -aemia* : Blood
*2. -algia* : Pain
*3. -derm* : skin
*4. -dynia* : pain
*5. -ectomy* : removal
*6. -Itis* : inflammation
*7. -lithiasis* : Presence of Stone
*8. -malacia* : softening
*9. -oma* : tumour
*10. -opia* : eye
*11. -osis* : Condition,excess
*12. -otomy* : incision of
*13. -phobia* : fear
*14. -plasty* : surgery
*15. -plegia* : peralysis
*16. -ptosis* : falling
*17. -rhoea* : excessive discharge
*18. -rhage* : to burst forth
*19. -rhythmia* : rhythm.
*20. -stasis* : stoppage of movement
*21. -sthenia* : weakness
*22. -stomy* : outlet
*23. -tomy* : removal
*24. -trophy* : nourishment
*25. -uria* : urine

✍Compounded Words - Meaning

*1. Anaemia* - Deficiency of haemoglobin in the blood
*2. Analgesic* - Medicine which alleviates pain
*3. Arthralgia* - Pain in a joint
*4. Cephalalgia* - Headache
*5. Nephralgia* - Pain in the kidney
*6. Neuralgia* - Nerve pain
*7. Myalgia* - Muscle pain
*8. Otalgia* - Ear ache
*9. Gastralgia* - Pain in the stomach
*10. Pyoderma* - Skin infection with pus formation
*11. Leucoderma* - Defective skin pigmentaion
*12. Hysterodynia* - Pain in the uterus
*13. Hysterectomy* - Excision of the uterus
*14. Nephrectomy* - Excision of a kidney
*15. Adenectomy* - Excision of a gland
*16. Cholecystectomy* - Excision of gall bladder
*17. Thyroidectomy* - Excision of thyroid gland
*18. Arthritis* - Inflammation of a joint
*19. Bronchitis* - Inflammation of the bronchi
*20. Carditis* - Inflammation of the heart
*21. Cervicitis* - Inflammation of the cervix
*22. Colitis* - Inflammation of the colon
*23. Colpitis* - Inflammation of the va**na
*24. Cystitis* - Inflammation of the urinary bladder
*25. Enteritis* - Inflammation of the intestines
*26. Gastritis* - Inflammation of the stomach
*27. Glossitis* - Inflammation of the tongue
*28. Hepatitis* - Inflammation of the liver
*29. Laryngitis* - Inflammation of the larynx
*30. Metritis* - Inflammation of the uterus
*31. Myelitis* - Inflammation of the spinal cord
*32. Nephritis* - Inflammation of the kidney
*33. Pharyngitis* - Inflammation of the pharynx
*34. Blepharitis* - Inflammation of the eyelids
*35. Cholelithiasis* - Stone in the gall bladder
*36. Nephrolithiasis* - Stone in the kidney
*37. Osteomalacia* - Softening of bones through deficiency of calcium or D vitamin
*38. Adenoma* -Benign tumour of glandular tissue
*39. Myoma* - Tumour of muscle
*40. Diplopia* - Double vision
*41. Thrombosis* - Formation of a blood clot
*42. Pyloromyotomy* - Incision of pyloric sphincter muscle
*43. Hedrophobia* - Fear of water(Rabies in humans)
*44. Neuroplasty* - Surgical repair of nerves
*45. Pyloraplasty* - Incision of plastic pylorus to widen passage
*46. Hemiplegia* - Paralysis of one side of the body
*47. Nephroptosis* - Downward displacement of the kidney
*48. Amenorrhoea* - Absence of menstrual discharge
*49. Dysmenorrhoea* - Painful menstruation
*50. Leucorrhoea* - Whitish va**nal discharge
*51. Menorrhoea* - Menstrual bleeding

12/12/2023

12/12/2023

🟥 Importance of Research in Physiotherapy 🟥

Research is of great importance in physiotherapy as it allows for the continuous improvement of the field through the discovery of new techniques, therapies, and interventions that can improve patient outcomes.

🔵 Here are some reasons why research is important in physiotherapy:

✅ Evidence-based practice: Research provides physiotherapists with evidence-based practice, which means that treatment plans are based on the best available evidence. Evidence-based practice ensures that patients receive the most effective and safe treatments possible.

✅ Improved patient outcomes: Research helps to identify the most effective treatments for specific conditions, which can lead to improved patient outcomes. This can include improved function, reduced pain, and a better quality of life for patients.

✅ Continuous improvement: Research helps to identify gaps in knowledge and areas where further research is needed. This leads to continuous improvement in physiotherapy and the development of new interventions and treatments.

✅ Professional development: Research is an essential part of professional development for physiotherapists. It allows them to stay up-to-date with the latest advancements in the field, which in turn helps them provide better care for their patients.

✅ Increased credibility: Research helps to establish physiotherapy as a credible and respected profession. Evidence-based practice is essential for establishing the credibility of any healthcare profession, and physiotherapy is no exception.

🛑 In conclusion, research is crucial for the advancement of physiotherapy. It is essential for evidence-based practice, improved patient outcomes, continuous improvement, professional development, and increased credibility of the profession. Physiotherapists should continue to engage in research to ensure that their practice is based on the best available evidence and that their patients receive the best possible care.

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Watch complete Course of Research Methodology
https://youtube.com/playlist?list=PLSIYn3-aLTUfkzBlqkAj-you3vLaDOlF0

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12/12/2023

A Comparative Study to Analyze the Perspectives, Interests, and Barriers Towards Research Project Among Undergraduate Students in The Universities of Faisalabad

Read Full article here
https://journals.umt.edu.pk/index.php/ihr/article/view/4897/2051

12/12/2023

Comparing the Effects of Post Facilitation Stretching and Active Release Technique on Pain, Pain Pressure Threshold and Patients Satisfaction in Upper Trapezius Trigger Points

Read Full article here
https://ajpojournals.org/journals/index.php/EJHS/article/view/1616/1739

12/12/2023

TREATMENT AND ASSESSMENT PREFERENCES FOR THE MANAGEMENT OF STROKE AMONG PHYSICAL THERAPISTS WORKING IN CLINICAL SETTING

Read Full article here
https://zenodo.org/records/4543721

12/12/2023

A comparative study to analyze the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis

Read Full article here
https://www.researchgate.net/publication/354275268_A_comparative_study_to_analyze_the_effect_of_planter_fascia_stretch_and_heel_pad_with_moist_heat_in_the_patients_of_planterfascitis

12/12/2023

Evaluation of Patients Satisfaction Level and Quality of Life (QOL) Receiving Physical Therapy Care for Musculoskeletal Disorders in Public and Private Hospitals

Read the full article here
https://thetherapist.com.pk/index.php/tt/article/view/145/99

12/12/2023

Efficacy of Transverse Friction Massage versus Dry Cupping on Flexor Digitorum Brevis and Gastrocsoleus in Patients with Planter fasciitis

Read the full article here
https://ajpojournals.org/journals/index.php/EJHS/article/view/1617/1740

12/12/2023

Frequency of Iliotibial Band Tightness and Its Association with Anterior Knee Pain in Healthcare Workers

Read Full article here https://ajpojournals.org/journals/index.php/AJHMN/article/view/1599/1723

11/12/2023

Honoured to contribute to the academic community by peer reviewing for "Work - A Journal of Prevention, Assessment and Rehabilitation"

✅HEC Recognised International Journal of Netherlands

▪️Category: W
▪️Scopus: Yes
▪️WoS: Yes
▪️(SJR) SCImago Journal Rank: 0.509
▪️Impact Factor: 2.3

22/11/2023

⭕ Taping of the lateral ankle for lateral ankle ligament injuries

🟦Materials: Non-elastic sports tape, kinesio tape or elastic adhesive tape.

🟦Joint position: The foot should be held at a 90° angle (0° anatomically) and slightly outward rotated.

🟦 Application steps:

▪️A: Start with the first anchor (white tape) 2 fingers above the top of the malleoli, around the lower leg, angling the ends upward in front to get a good anatomical fit.

▪️B: Add a second anchor with tape above and parallel with the first overlapping approximately 1 cm (0.5 in.).

▪️C: Identify the base of the 5th metatarsal.

▪️D: Support 1: From underneath the foot stretch a 'straight’ piece of tape from the 5th metatarsal base using the front half of the tape (tan colored tape) to cover the base diagonally upwards towards the Achilles tendon and the anchors on the lower leg, finishing over the posterior midline.

©️Tommy eriksson, Swedish athletics association

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16/11/2023

🟦 Palpation of superficial nerve

▪️Finger gliding on the skin

You can locate the superficial nerves by sliding your finger along the length of the nerves. The easiest way to palpate them is by sliding your finger tip over the skin from the place where the nerve perforates the fascia, moving distal to proximal

▪️ Tweezer Method

The tweezer method is another way to palpate the superficial nerve branches. This can be done in all areas where the skin is thin and does not adhere tightly to the underlying layers. Place your fingers distal to the area where a nerve theoretically should be close to the surface. With your thumb and index finger lightly pinch a fold of skin and subcutaneous layer (finger tips should be at a right angle to the assumed course of the nerve). Roll the skinfold carefully back and forth between the finger tips. Be careful not to pinch the skin too hard, as this would be painful.

©️ Ref : Book - Manual Therapy for the Peripheral Nerves by A.T. Still

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15/11/2023

⭕ Nerve fiber lesion

⭕ Schematic presentation with description of the conductivity speed

©️ Bisschop and Dumoulin 1992
©️ Ref : Book - Manual Therapy for the Peripheral Nerves by A.T. Still
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