Robert (Right Shoulder AC joint) (Person (Dialoguism (Verbal language -…
Robert (Right Shoulder AC joint)
The pt is very active, which works well with the internal values of P360 to be very active and to promote exercise as a treatment. Being able to effectively explain this to the pt is also a favourable trait of the P360 staff.
Narrative Based Reasoning
Pt reported right shoulder pain following a bicycle accident 2 weeks ago, where he landed heavily on the back of his right shoulder.
Pt unable to lift arms above O/H. Can swim 1km before having to cease activity due to shoulder pain. Complains of weakness in right arm making it difficult for him to work. Pt runs an air-conditioning installation company.
Pt leads a very active lifestyle, full of swimming, cycling, running, mixed martial arts (BJJ) as well working out in the gym.
Wants to get back to being able to run, swim, train and work without shd pain
Verbal language - confident and informative tone
Able to explain the injusry to the pt using a mixture of anatomical and laymans terms - pt followed the conversation easily and understood what was said.
Pt has a basic understanding of muscles and joints.
Pattern recognition (Practice based evidence)
Heavy impact through shoulder, pain over AC joint during horizontal ADD of right arm = AC joint strain.
An injury like this to the shoulder would cause the surrounding muscles to 'switch off' and/or tighten up as a protective mechanism. Leading to poor activation and motor control of muscles.
Poor movement quality due to muscles 'swtiched off' and others being tight
Screen major muscles in the region for tightness as a protective mechanism, eg. lats/pec minor/bicep
Evidence based practice
Activation exercises to wake up 'lazy' muscles
Strength training program over the course of 4-6 weeks for strength gains
STM, trigger point needling - to release tight muscles
Pt reporting pain in postero-lateral right shoulder
OBSERVATION: Anterior- Right clavicle more pronounced than left. Right upper trap muscle belly bigger than left UT. Posterior - Depressed Right shoulder
THOUGHT: Rotator cuff injury, spine of scapular fracture, posterior deltoid injury, C5/6 referred pain
OBJECTIVE: GHJ flexion: some pain, average movement quality. GHJ ABD: pain during movement, more so on controlled ADD, poor movement quality.
THOUGHT: Potentially tight lats/teres major, coracobrachilis, short head of bicep which would anteriorly tilt the scapular, making the trapezius muscle belly look bigger than it is and make the shoulder appear to be depressed compared to contra-lateral side.
Rx: Trigger point dry needling in lats, and short head of bicep. Re-Ax (anteriorly) showed a reduction in 'size' of R.UT muscle belly and reduced differences between L and R.Clavicle
Rx in Gym: Single arm shrugs with straight elbow 3 x 10 focusing on correct muscle activation. Shoulder ABD with red t/b to 45 deg, 3 x 10
Re-AX Movement: GHJ Flexion and ABD had a marked improvement in movement quality as well as a reduction in pain during the movement.
Diagnosis: AC joint strain with secondary R.C tendinopathy
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THOUGHT: Poor muscle activation of deltoids, R.C, scapulo-thoracic muscles.
Rx: Combination of tissue release and exercises for activation