Optimising Physiotherapy Management of Rotator Cuff Related Shoulder Pain: A Case Study

Abstract

: Background and Purpose: More than 70% of patients undergo tests for the rotator cuff - related shoulder pain (RCRSP). Symptomatic partial and full thickness, rotator cuff tendinopathy, subacromial discomfort, and impingement syndrome are a few of the shoulder conditions that are included in the general category of RCRSP. This study was done to know how evidence based practice will cut down the rehabilitation time if patient approaches to physiotherapy department appropriately. Case Description: A patient in her 60s came to the physiotherapy department with the chief complaint of sudden pain and unable to move her left shoulder with no strength, which was impeding her activity of daily living. Before she came to physiotherapy department, she consulted an orthopedic doctor, and was suspected to be a case of brachial neuritis, the doctor advised for investigation, where an MRI of the shoulder showed mild joint effusion associated with synovial thickening, moderate to severe AC joint arthrosis, and supraspinatus tendon showed mild tendinosis with interstitial tears but the rotator cuff configuration signal was within normal limits. The consultant doctor advised physiotherapy. While she was examined in physiotherapy department, the patient had no active range in the left shoulder with no strength and motor control in shoulder muscles. Pain on NPRS was 7 on movement in the left shoulder. However, the diagnosis was complex as the patient's presenting signs made it difficult to diagnose without investigations. In investigation reports correlation was more towards age related degenerative changes. A clinical prediction rule was used where the score was 5/5 which suggested a partial or large rotator cuff tear along with a drop arm test positive. The treatment program was framed using clinical practice guidelines. Outcomes were evaluated with NPRS, Active ROM, and strength with a hand - held dynamometer on day 1 and day 30 with regular follow - ups with the consultant doctor. Outcome: NPRS, Handheld dynamometer – fitmust. Discussion: A case study of Rotator cuff related shoulder pain where the patient presentation and reports were not merely matching, Evidence - based physical therapy management in rehab program made her regain her functional activities within a span of 30 days and did not required any surgery as mentioned by the surgeon. More than 70% of patients experiencing shoulder pain undergo testing for shoulder pain related to the rotator cuff (RCRSP). using the clinical prediction rules and clinical practice guidleines the diagnosis and treatment protocol was tailored made.