Fysio forum

01/06/2022

for .

Pain Assessment Scales.

1.Numerical Rating Scale (NRS)
2. Visual Analog Scale (VAS)
3. Defense and Veterans Pain Rating Scale (DVPRS)
4. Adult Non-Verbal Pain Scale (NVPS)
5. Pain Assessment in Advanced.
6. Dementia Scale (PAINAD)
7. Behavioral Pain Scale (BPS)
8. Critical-Care Observation Tool (CPOT)

There are many different kinds of pain scales, but a common one is a numerical scale (NRS) from 0 to 10. Here, 0 means you have no pain; one to three means mild pain; four to seven is considered moderate pain; eight and above is severe pain.

25/05/2022

Q. Adhesive capsulitis(define, types, stages, investigation, causes, clinical features, risk factors & PT management)

Definition:
Inflammation of the Capsule and Synovial membrane of the shoulder joint leading to Adhesion formation that results progressive pain and movement stiffness or restricted of the shoulder joint is called frozen Shoulder.

There are 2 types of frozen shoulder-
Primary –Idiopathic
Secondary – Due to risk factors

★ Stages of ‘Frozen Shoulder’

There are 3 classical stages in frozen shoulder.

Stage 1: Freezing stage or painfulstage
Duration: 6 weeks to 9months

Stage 2: Frozen stage or adhesive stage
Duration: 5 to 12 months

Stage 3: Thawing stage or recovery stage
Duration: 5 to 26 months

Investigation:

Plain X-ray ofshoulder
Non-contrastMRI
Invasive arthroscopy
Physicalexamination
Specialtest:
-LAM test

Causes:

Age: 40plus
S*x: Female-45-55years & male 50-60years
Trauma
Dislocation
Fracture
Hemiplegia
Diabeticsmellitus.

Clinical features :

1. Progressive pain, stiffness of shoulder joint 2.Movement restricted
3.Deformity
4.Oedema
5.Pain increase at night over deltoid region 6.Loss of function / movement
7.Muscle spasm-pectoralis major, latissimus dorsi.

Risk factors Primary:

Rotator Cuffpathology
Bicipitaltendinitis
Acromioclavicular jointarthritis

Secondary:
DiabetesMellitus
Stroke
Hyperthyroidism
Ischemic heartdisease
Prolongimmobilization.

PT management:

Aims of treatment:
1.To relief pain
2.To reduce swelling
3.To prevent deformity
4.To improvemusclepower
5.To increase circulation
6.To prevent muscle spasm
7.To rehabilate thepatient

Treatment procedure:

Stage 01:

Stretching
Range of motion exercise
Pendulum exercise

Stage 02:

Stretching
Mobilisation
Anterior posterior glide
Abduction adduction glide
End range mobilization

Stage 03:

Stretching
All types of shoulder movements
Swimming

Home exercise:
Pulley exercise
Wall climbing exercise
Towel pull exercise

13/05/2022

13/05/2022

CERVICAL RADICULOPATHY
( Tests And measures , Rehabilitation , Functional goals )

Tests And measures :

• Cervical spine AROM
• Sharp–Purser: Atlantoaxial instability
• Cervical passive intervertebral motion testing
• Sub-cranial translation instability testing
• Passive physiological intervertebral mobility testing (PPIVM)
• Upper-extremity screening examination
• Postural examination
• Muscle length testing, including upper trapezius, levator scapulae,
pectoral muscles
• Upper limb nerve tension test
• Neck Disability Index (NDI)
• Deep neck- exor endurance test
• Upper-extremity neurological screen
(dermatome, myotome, reflexes)

Rehabilitation :

• Rest
• Joint manipulation to the thoracic and upper-cervical spine
• Cervical distraction and traction to relieve nerve compression
• Cranio-cervical exion exercises
• Periscapular strengthening
Periscapular meaning ( serratus anterior , levator scapula , pectoralis minor , rhomboids, and trapezius )

• Address pain

○ Electrical stimulation
○ Heat/Ice to increase mobility
• Address hypertonicity
○ Soft tissue massage
○ Heat
• Address muscle weakness
○ Deep neck-flexor training
○ Strengthening of lower/middle trapezius, rhomboids, rotator cuff
Serratus anterior, latissimus dorsi

Functional Goals :

• Patient will be able to
○ Sit with a neutral cervical and thoracic spine posture for > 30
minutes with 0/10 pain rating.
○ Patient will be able to sit at work station and perform computer
work for 45 minutes with 0/10 pain rating.
○ Patient will be able to rotate cervical spine 70 degrees to talk on
phone with 0/10 pain rating in the neck or arm.

25/03/2022

💥Shoulder impingement💥

Shoulder impingement refers to pinching or compression of the rotator cuff tendons as you lift your arm up. As you raise your arm, the tendons may become compressed between the shoulder bone (humerus) and the front of the shoulder blade (acromion). The compression often causes irritation to the tendons, resulting in inflammation and pain (see image below). This subsequently causes the rotator cuff muscles to stop working properly, which further aggravates the problem.

💢Physiotherapy💢
Early goals of physiotherapy will be the following:

• To determine the structures injured.
• To determine not only what to treat, but why it happened.
• Encourage early, pain-free movement to prevent stiffness.
• Manage pain using hands-on-therapy to restore appropriate shoulder alignment and muscle imabalances.
• Educate regarding activities and positions to avoid, as well as a plan about returning to activity.
• Tape the shoulder in a position to restore appropriate alignment.
• Manage inflammation using modalities (medical instruments to aid in tissue healing).
• use hands-on-therapy to ‘release’ tight muscles to restore alignment and muscle imbalances.
• Specific muscle stretching to decrease tension in the back of the shoulder
• Continue to promote pain-free movement in the shoulder, gradually progressing to shoulder level and above shoulder level activities as tolerated.
• Dry needling to ‘reset’ muscles, decrease pain, improve healing and restore movement.
• Strengthening the rotator cuff and supporting muscles to promote proper, pain-free movement
• Perform tests to determine whether you are ready to return to activity.
• Educate regarding frequency/intensity of activity you should be doing based on the assessment.
• Prescribe specific exercises to promote movement and strength in areas necessary for your activity.
• Continue with shoulder level and overhead strengthening as necessary.
• Encourage higher intensity, dynamic exercises at last.

21/03/2022

21/03/2022

CUFF INJURY AND TREATMENT

The rotator cuff forms a group of muscles and tendons that keep our shoulder joint stable.

The rotator cuff muscles are four strong muscles usually known commonly as SITS muscles, where each of the letters in the “SITS” represents single muscle. S-Supraspinatus, I-Infraspinatus,T-Teres minor and S-Subscapularis.

Injury to any of the tendons and muscles of these causes deep dull aching pain, sometimes with weakness and reduced shoulder range of motion.
This injury is referred to us rotator cuff injury.

Generally, the injury to the tendon must heal by two to four weeks but most stubborn cases can last several months. Normally, the cause of this injury can be of one of three reasons;

📍Substantial injury to the shoulder
📍Wear and tear of the tendon tissue
📍Repetitive overhead activity or lifting of heavy loads over prolonged period may also irritate or cause damage to the tendon.

There are other risk factors that can also pose one’s risk higher for rotator cuff injury. These involve;

1. Age: As one ages, the tendon undergoes wear and tear and this can go a long way to trigger the symptoms of rotator cuff injury. Data available reveals that people who are 60 years and older are diagnosed of this injury.

2. Construction Jobs: Most construction jobs involves carrying activities and liftings. These activities are done overhead and the tendons can easily get irritated.

3. Family History: It is also established that, rotator cuff injury can also have familial traces. Often when a relative in the family has the injury, you also stands a higher risk.

of the injury can give us an impression about having a rotator cuff injury. Often,the injury comes with severe pains in the shoulder that often feels dull and deep. This pain often disturbs sleeping at night and can go along way to affect some common routine activity such as combing aid hair and others that require lifting of the arm.

When rotator cuff injury is not treated, there can be weakness in the shoulder and shoulder range of motion will become drastically reduced which will affect our daily activities.



The treatment of rotator cuff injury can be medical or physiotherapy. In instances where the injury is so severe that, there is total tear or rupture of a tendon, then surgery can be opted for the repair of the tendon. Most of the cases however occurs in a mild form where surgery will not be an option then.

Physiotherapy treatment for rotator cuff injury are geared towards preventing subsequent injuries and also reduces pain and facilitate shoulder Rom for functional activities. The protocols can be that which help in strengthening the shoulder muscle, improve shoulder range of motion as well as reduces the discomfort symptom which is pain.

There are exercises specially prescribed to promote strength, Rom, of the muscles and the shoulder joint respectively. Pain management can be done through application of certain modalities which pose no side effect. In common cases, acute cases can be managed with cold therapy whilst chronic and subacute cases can be managed via hot therapy. Always strengthening exercises commence as soon as pain is contained. Until the healing totally occurs, activity limitation is advised.

The activities that pose higher risk to the development of rotator cuff injury, must be ceased.
This will help provide a healing grounds for the tendon to heal faster. It is important to consult your doctor for thorough assessment to ascertain whether your injury is rotator cuff injury.