CASE STUDY- 30

Demographic Details

Patient’s Name – Ajay Verma

Hospital – Sitaram Bhartia Hospital

Weight – 66kg

Age/sex – 32/M

Chief complaint

 Pain and swelling in the right knee.

 Difficulty in moving the knee.

History

~ Previous illness – No

~ Onset – 3 weeks

~ Medical – No

~ Surgical – No

Pain Assessment

~ V.A.S – 9/10

~ Type of pain – soft tissue and joint pain

~ Quality of pain – Sub- acute

~ Aggravating fator- over extension

Observation / Palpation

~ Swelling – Yes

~ Redness –No

~ Tenderness – Yes
~ Temprature – Increased

Examination

~ R.O.M – Decreased with pain

Extension decreased to 00
~
M.M.T – Knee jt. – Rt.| Lt.

Flexor – 2/5|3/5

Extensor- 1/5|3/5

Hip jt – Rt. |Lt.

Flexor - 3/5|3.5/5

Extensor – 3/5|3.5/5

Adductor – 3/5|3/5

Abductor – 3/5|3/5

Diagnosis – Post ACL reconstruction and meniscal tear.

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle stiffness
 Increasing muscle strength

Treatment Plan

 IFT
 Cold pack
 Ultrasound
 Mild ROM

Precautions / Home Advice

 Avoid over extension

 Avoid lifting heavy weights
 Avoid jerking movements
  Avoid prolong standing
 Mild ROM and cold pack

Case study- 29
Demographic Details

Name-MR. Naman singh

Age-60

Gender- Male

Address- Humanyupur

Occupation- EX. Army man

Hospital- Sitaram bhartia hospital

Chief Complaint

 Pain in left shoulder joint.

  Difficulty in most of the movements Like falling while walking.

History

Past:-

1)- Medical- Hypertension.

2)- Surgical- ABSENT.

PSYCHOLOGICAL:- NONE

Pain assessment

* NPRS- 6/10

* Type of pain- Chronic And Nerve pain.

* Quality of pain- Sharp.

EXAMINATION

1)-Observation/ palpation.

*Swelling- PRESENT

*Redness- Absent

*Temperature- Normal

*Tenderness- Present

* Gait pattern of patient-Half circumductory gait.

* Built- Healthy

2-Motor examination

*R.o.m- *Active shoulder and elbow movements .( upper limb) LEFT

Passive forearm and wrist and finger movements.

* Active hip and knee movements (lower limb)LEFT

Passive ankle movements

* M.M.T LT

LOWER LIMB
HIP (FLEX,EXT,ABD,ADD) – 2

( EXT& INT ROT.)- 1

KNEE (FLX,EXT)- 4

ANKLE (DOR.FLX,PLNT.FLEX)- 1

UPPER LIMB

SHOULDER AND ELBOW- 2 (ALL MOVEMENTS)

Forearm and wrist – 1 (ALL MOVEMENTS.)

Diagnosis- LT.side Hemiparasis.

Goals-

*Increase ROM

* Reduce the spasticity.

* Increase the muscle strength.

* Improve muscle power.

* Improve balance and coordination.

Treatment plan:-

1)- Muscle stimulator and Hotpack for 15 mint.

2)- Balance and coordination exercise.

3)-Strengthening and stretching exercise.

4- Gait training

5- PNF, Frenkel exercise, Bridging exercises.

Precaution & Home advices..

1-Avoid heavy lifting.

2- Avoid any jerky movements.

 Case study- 28
Demographic Details

Name- Monika verma

Age-64

Gender- Female

Address-Yamuna vihar.

Occupation- Advocate

Hospital- Sitaram bhartia hospital.

Chief Complaint

 Pain in both knee since 1 year.

History

Past:-

1)- Medical- Hypertension ,DM

2)- Surgical- NO

PSYCHOLOGICAL:- NONE

Pain assessment

* NPRS- 7/10

* Type of pain- Chronic and joint pain.

* Quality of pain- Dull

EXAMINATION

1)-Observation/ palpation.

*Swelling- Absent

*Redness- Absent
*Temperature- Normal

*Tenderness- Absent

* Gait pattern of patient-waddling

* Built- Mesomorphic

2-Motor examination

*R.o.m- Active knee

Flexion- 10 to 125degree(RT) & 10 to 125(LT)

Extension- 125 to 10 bot

* M..M.T- RT/LT ( All Movements)

Hip-4/4

knee-4/4

Ankle – 4/4

Diagnosis- B/L Knee joint osteoartheritis.

Goals-

*Reduce the pain.

* Improve the ROM.

* Increase the muscle strength.

* Improve gait pattern.

Treatment plan:-

1)- wax bath for 20 min

2)- IFT – 15min

3)- US - 6 min.

4- B/L Quads and Hems isometrics exercise.

5- B/L joint mobilization

6- Gait training.
Precaution & Home advices..

1-Avoid heavy lifting.

2- Avoid any jerky movements.

3- Avoid cross sitting

4- Avoid prolong sitting and standing

Case study- 27
Demographic Details

Name- Pramod kumar.

Age-50

Gender- Male

Address- safdarjung enclave

Occupation- Delhi police.

Hospital- Sitaram bhartia hospital.

Chief Complaint

 Pain in left elbow.

History

Past:-

1)- Medical- * ABSENT

2)- Surgical- ABSENT

PSYCHOLOGICAL:- NONE

Pain assessment

* NPRS- 5/10

* Type of pain- Acute and muscular pain.

* Quality of pain- Sharp.

EXAMINATION

1)-Observation/ palpation.

*Swelling- Absent

*Redness- Absent

*Temperature- Normal

*Tenderness- Absent

* Gait pattern of patient-Normal

* Built- Mesomorphic

2-Motor examination

*R.o.m- Active full rom .( upper limb)

Diagnosis- Lateral epicondylitis

Goals-

*Reduce the pain.

* Reduce the muscle spasm.

* Increase the muscle strength.

* Restore normal ROM

Treatment plan:-

1)- SWD for 15 min

2)- Joint Mobilization exercise.

3)-IFT - 15 min.

4- Ultrasonic- 10min.

Precaution & Home advices..

1-Avoid heavy lifting.

2- Avoid any jerky movements.

 Case study- 26
Demographic Details

Name-MR. Ram.

Age-62

Gender- Male

Address- Hauz khas

Occupation- RETD.

Hospital- Sitaram bhartia hospital.

Chief Complaint

 Pain in left shoulder.

 Stiffness in morning.
 Pain at resting time
 Difficulty in movement of shoulder.
 Pain aggravates in night and lead to difficulty in sleeping.

History

Past:-

1)- Medical- * DM

2)- Surgical- NO

PSYCHOLOGICAL:- NONE

Pain assessment

* NPRS- 6/10

* Type of pain- Chronic joint pain

* Quality of pain- Dull.

EXAMINATION

1)-Observation/ palpation.

*Swelling- Absent

*Redness- Absent

*Temperature- Normal

*Tenderness- Absent

* Gait pattern of patient-Normal

* Built- Mesomorphic

2-Motor examination

*R.o.m- Active .( upper limb) shoulder

RT/LT

Flexor- 180/120

Extensor- 60/20

Abductor-125/normal

Adductor- 150/ normal

Diagnosis- Periarthritis lt. shoulder joint.

Goals-

*Reduce the pain.

* Reduce the muscle spasm.

* Increase the muscle strength.

* Restore normal ROM

Treatment plan:-

1)- SWD for 15 min

2)- Joint mobilization exercise.

3)-IFT - 10 min.
4- Ultrasonic- 10min.

5- Pendulum exc., shoulder wheel, finger ladder, shoulder pulley.

Precaution & Home advices..

1-Avoid heavy lifting.

2- Avoid any jerky movements.

CASE STUDY- 25

Demographic Details

Name-Mrs. kusum

Age-65

Gender- Female

Address- Green park

Occupation- Housewife.

Hospital- Sitaram bhartia hospital.

Chief Complaint

 Pain in lower back since 1 yr. and both side lower limb pain.
History

Past:-

1)- Medical- * Hypertension since 10 years.

 Diabetes since 7 yrs

 Thyroidism since 5-10yrs

2)- Surgical- Cataract surgery of left eye.

PSYCHOLOGICAL:- NONE

Pain assessment

 NPRS- 8/10
 Type of pain- Chronic and nerve pain.
 Quality of pain- Sharp and shooting.

EXAMINATION

1)-Observation/ palpation.

 Swelling- Absent
 Redness- Absent
 Temperature- Normal
 Tenderness- Absent
 Gait pattern of patient-waddling gait
 Built- (obese) ectomorphic

2-Motor examination

R.o.m- knee joint

Flexion- 80degree(RT) and 70degree(LT)

Extension- normal

3. M.M.T- RT/LT ( All Movements)

KNEE-flexors-4/5

Extensors- normal.
Diagnosis- Lumber Spondylosis

Goals-

 Reduce the pain.

 Improve the blood circulation.
 Increase the muscle strength.
 Regain Normal ROM

Treatment plan:-

 SWD for 20 min

 Ultrasonic-15mint
 Tens - 20 min.
 Back Strengthening exercises.

Precaution & Home advices..

 Avoid heavy lifting.

 Avoid any jerky movements.
 Avoid forward bending
 Avoid prolong standing and sitting.
 Use lumbo-sacral belt.
 Use orthopedic mattress.
 CASE STUDY- 24

DEMOGRAPHIC DETAILS :

Patient Name - Mrs Ravinder Sodhi

Age/Sex - 67/Female

Occupation - house wife

Hospital – Sitaram Bhartia Hospital

CHIEF COMPLAINT : lower back pain with pain also in both lower limbs

HISTORY :

1. History of present illness -

 Onset - last 20 days

 Pain duration- on and off pain during activities
 Nocturnal variation - nill

2. Medical History - diabetes mellitus, on medications

3. Surgical History - nill

4. Family History - diabetes mellitus

OBSERVATION :

Built - endomorph

Posture - normal

External appliance - nill

PALPATIONS:

 Swelling - absent
 Redness - absent
 Temperature - normal
 Tenderness - present
EXAMINATION :

 Nature of Pain - aching in lower back, numbness and tingling in lower limbs
 Aggravating Factors - walking and activities of daily living
 Relieving Factors - resting
 VAS - 5
 Range Of Motion - normal
 MMT grade - (3+) for all muscle groups of hip joint movements

RADIOLOGICAL INVESTIGATIONS - X-ray and MRI

PROBABLE DIAGNOSIS - prolapsed inter-vertebral disc (PIVD)

GOALS-

 Short term - pain management and development of painless active ROM

 Long term - strengthening of back and leg muscles

TREATMENT -

 IFT
 Moist hot pack
 Ultrasound therapy on lower back
 Exercises - ankle toe movements, knee ROM, hip abduction and adduction, straight leg
raises

HOME ADVICES -Avoid forward bending, heavy weight lifting, long distance walking or
travelling .

CASE STUDY- 23

DEMOGRAPHIC DETAILS :

Patient’s Name: Mr Sanjeet

Age/sex: 28/male

Occupation: business man

Hospital : Sitaram Bhartia Hospital

CHIEF COMPLAINT : unable to do wrist and finger movements properly, unable to make fist
due to injury
HISTORY :

 Onset- injury occurred 1 month ago by grinding machine in factory

 Nocturnal variations - nill
 Medical history - nill
 Surgical history - stitches on injury for tendon repair
 Family history - not relevant

OBSERVATIONS :

 Built - mesomorph
 Posture - wrist and fingers remains extended
 External appliances - nill

PALPATIONS :

 Swelling - mild
 Redness- absent
 Tenderness - present
 Temperature - warm

EXAMINATION:

 Nature of pain - aching

 Aggravating factors -activities by hands
 Relieving factors - resting
 VAS - 7
 Range of motion - almost fully restricted
 MMT grade - (2) for thumb flexion,extension, adduction and abduction ,(2) for radial
deviation

RADIOLOGICAL INVESTIGATIONS : X-rays

PROBABLE DIAGNOSIS : Injury of thumb tendons

GOALS: pain reduction, stiffness reduction, improvement of ROM and strengthening

TREATMENT :
  Ultrasound therapy at thenar eminence
 Paraffin wax bath covering whole hand and wrist
 Active assisted exercise
 Exercises for active ROM
 Gripping exercises
 Hand function table

HOME ADVICES: don't over exercise, take proper rest after exercising,use ice packs in case
of swelling and pain

CASE STUDY- 22

DEMOGRAPHIC DETAILS :

Patient’s Name : Mrs Sneha Gupta

Age/sex: 61/female

Occupation : retired government official

Hospital name : Sitaram Bhartia Hospital

CHIEF COMPLAINT : Unable to stand and walk properly

HISTORY :

 Onset of present problem - gradual

 Nocturnal variations - nill
 Medical history - nill
 Family history - not relevant

OBSERVATIONS :

 Built - ectomorph
 Posture- normal
 External appliances - nill
  Gait- limping

PALPATIONS:

 Swelling - absent
 Redness- absent
 Tenderness - absent
 Temperature - normal

EXAMINATIONS :

 Pain- absent
 VAS - N/A
 ROM-normal
 MMT grade - all hip joint movements- (4-)

Knee movements - (4-)

Ankle movements - (3+)

RADIOLOGICAL INVESTIGATIONS : not relevant

PROBABLE DIAGNOSIS - Muscle weakness

GOALS- Strengthening of hip and lower limb muscles

TREATMENT :

 Moist pack
 Strengthening exercises with quadriceps chair, gym ball, theraband and sandbags

HOME ADVICES : daily walking practice, don't over exercise and take nutritional and healthy
food
 CASE STUDY- 21

DEMOGRAPHIC DETAILS :

Patient’s Name : Ms Radhika Singh

Age/sex: 34/female

Occupation : teacher

Hospital : Sitaram Bhartia hospital

CHIEF COMPLAINT : difficulties in activities of daily life like combing hair

HISTORY :

 Onset: 2 months ago

 Medical history: diabetes mellitus
 Surgical history: nill
 Family history: diabetes mellitus

OBSERVATIONS:

 Built- endomorph
 Posture- normal
 External appliance- nill
 Dominance - right

PALPATIONS -

 Swelling - present
 Redness- present
 Temperature -warm
 Tenderness - present
EXAMINATIONS:

 Nature of pain- aching

 Aggravating factors- shoulder movements
 Relieving factor- rest
 VAS - 7
 Range of motion- moderately restricted shoulder flexion, abduction and external rotation
 MMT grade - (3-) for shoulder flexion, abduction and external rotation
o Other shoulder movements - (3+)

RADIOLOGICAL INVESTIGATIONS: X-ray

PROBABLE DIAGNOSIS- adhesive capsulitis (frozen shoulder) of left side

GOALS:

 Short term- pain reduction and improvement of active ROM

 Long term- strengthening of shoulder and arm muscles

TREATMENTS:

 Ice pack
 Ultrasound therapy
 Pendular exercises of shoulder
 Overhead pulley
 Finger shoulder ladder
 Shoulder wheel exercises

HOME ADVICES: Don’t sleep in side lying position with affected side below, exercise at least
twice a day

CASE STUDY- 20

Demographic Details

Patient’s Name – Mr. SR Banerjee

Hospital – Sitaram Bhartia Hospital

Weight – 74 kg

Age/sex – 47/M

Chief complaint

 Decreased mobility.
 Stiffness
 Pain in radiating to the entire leg
 Heavyness

History

 Previous illness – Not known

 Onset – 6 Months
 Medical – No
 Surgical – No

Pain Assessment

~ V.A.S – 6/10

~ Type of pain – Muscular and sensory

~ Quality of pain – Chronic

Observation / Palpation

~ Swelling – No

~ Redness - No

~ Tenderness – No

~ Temprature – No

Examination
~ R.O.M – Restricted

Diagnosis - Backache with radiculopathy

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle stiffness
 Increasing muscle strength

Treatment Plan

 Back exercise
 Hot pack
 IFT (at centre back)
 SWD (at back)

Precautions / Home Advice

 Avoid bending
 Regular walks
 Exercise and hot packs

CASE STUDY- 19

Demographic Details

Patient’s Name – Kanika Singh

Hospital – Sitaram Bhartia Hospital

Occupation – Government job

Weight – 56kg

Age/sex – 30/F

Chief complaint

 Severe back pain

 Difficulty in maintaining a particular posture for a long time.
History

~ Previous illness – No

~ Onset – 2 weeks

~ Medical – No

~ Surgical – No

Pain Assessment

~ V.A.S – 8/10

~ Type of pain – Muscular

~ Quality of pain – Sub- acute

~ Aggravating fator- Prolong sitting

Observation / Palpation

~ Swelling – No

~ Redness –No

~ Tenderness – No

~ Temprature – No

Examination

~ R.O.M – Decreased with pain

Diagnosis – Lower back ache

Goals

 Decreasing pain
 Increasing mobility
 Decreasing tension in back
 Increasing muscle strength

Treatment Plan
  IFT
 Hot pack
 Ultrasound

Precautions / Home Advice

 Avoid forward bending

 Avoid lifting heavy weights
 Avoid jerking movements
 Avoid prolong sitting and standing
 Back exercise and hot pack

CASE STUDY- 18

Demographic Details

Patient’s Name – Ms. Shraddha Anand

Hospital – Sitaram Bhartia Hospital

Weight – 23kg

Age/sex – 9/F

Chief complaint

 Pain and discomfort in the left elbow after gymnasts.

 Decreased mobility
 Swelling and tenderness

History

 Previous illness – No
 Onset – 45 days
 Medical – No
 Surgical – No

Pain Assessment

 V.A.S – 6/10
 Type of pain – Muscular and continous
 Quality of pain – Sub- acute
 Aggravating factor – Flexion and extension of elbow
Observation / Palpation

 Swelling – No
 Redness –No
 Tenderness – Yes
 Temprature – No

Examination

~ R.O.M –

 Decreased
 Elbow flexion(0-200)
Extension(90-700)

Diagnosis – Supra-condylar injury of the left elbow joint

Goals

 Decreasing pain
 Increasing mobility
 Decreasing muscle stiffness
 Increasing muscle strength

Treatment Plan

 Muscle stimulator
 Ice pack
 Ultrasound
 ROM ( Shoulder, elbow and wrist)

Precautions / Home Advice

 Avoid lifting heavy weights

 Avoid jerking movements
 Icing regularly
 CASE STUDY- 17

Demographic Details

Patient’s Name – Manish Tiwari

Hospital – Sitaram Bhartia Hospital

Weight – 72kg

Age/sex – 28/M

Chief complaint

 Pain and swelling in the right knee joint.

 Difficulty in extension of right knee .

History

~ Previous illness – No

~ Onset – 3 weeks

~ Medical – No

~ Surgical – No

Pain Assessment

~ V.A.S – 9/10

~ Type of pain – soft tissue and joint pain

~ Quality of pain – Sub- acute

~ Aggravating fator- over extension

Observation / Palpation

~ Swelling – Yes

~ Redness –No

~ Tenderness – Yes
~ Temprature – Increased

Examination

~ R.O.M – Decreased with pain

Extension decreased to 00
~
M.M.T – Knee jt. – Rt.| Lt.

Flexor – 2/5|3/5

Extensor- 1/5|3/5

Hip jt – Rt. |Lt.

Flexor - 3/5|3.5/5

Extensor – 3/5|3.5/5

Adductor – 3/5|3/5

Abductor – 3/5|3/5

Diagnosis – Post ACL reconstruction and meniscal tear.

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle stiffness
 Increasing muscle strength

Treatment Plan

 IFT
 Cold pack
 Ultrasound
 Mild ROM

Precautions / Home Advice

 Avoid over extension

 Avoid lifting heavy weights
 Avoid jerking movements
  Avoid prolong standing
 Mild ROM and cold pack

CASE STUDY- 16

Demographic Details

Patient’s Name – Ramesh

Hospital – Sitaram Bhartia Hospital

Weight – 82kg

Age/sex – 54/M

Chief complaint

 Difficulty in coordination and focusing on the right side of the face.

 Decreased muscular tone on the right side.
 Unable to make expressions.
History

~ Previous illness – No

~ Onset – 2 months

~ Medical – Diabetes, hypertension

~ Surgical – Liver transplant

Pain Assessment

~ V.A.S – 4/10

~ Type of pain – sensory

~ Quality of pain – Chronic

~ Aggravating factor- Cold

Observation / Palpation

~ Swelling – No

~ Redness –No

~ Tenderness – No

~ Temprature – No

Examination

~ R.O.M – Decreased (altered expression)

Diagnosis – Right side Bell’s palsy

Goals

 Increasing muscle tone

 Increase secreating
 Improve facial expression

Treatment Plan

 Fascial stimulations
  Fascial massage
 Expression exercise

Precautions / Home Advice

 Chewing gum
 Ballon blowing
 Vowels exercise

CASE STUDY- 15

Demographic Details

Patient’s Name – Mr. Berward Marker

Hospital – Sitaram Bhartia Hospital

Weight – 82kg

Age/sex – 36/M

Chief complaint

 Heel stiffness
 Painful dorsiflexion of left foot

History

 Previous illness – No
 Onset – 8 months
 Medical – No
 Surgical – No

Pain Assessment

 V.A.S – 5/10
 Type of pain- Muscular and sensory both
 Quality of pain – Chronic
 Aggravating factor- Running and jogging
Observation / Palpation

 Swelling – Yes
 Redness –No
 Tenderness – Yes
 Temprature – normal

Examination

~ R.O.M – Decreased
~
M.M.T – Ankle jt. – Rt.| Lt.

Dorsi Flexor – 3/5|2.5/5

Plantor flexor - 3/5|3/5

Invertors – 3/5|3/5

Evertors – 3/5|2.5/5

Diagnosis – Degenerative changes at the achillis tendon

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle stiffness
 Increasing muscle strength

Treatment Plan

 IFT
 Calves stretch
 Ultrasound
 Micro massage
 Right foot stregthning

Precautions / Home Advice

 Icing
 Avoid running
 Avoid toe walking
 Avoid prolong standing
 CASE STUDY- 14

Demographic Details

Patient’s Name – Ganesh Dutt

Hospital – Sitaram Bhartia Hospital

Weight – 76kg

Age/sex – 38/M

Chief complaint

I have discomfort in the neck and unable to sleep in a particular position.Stiffness and
decreased mobility.

History

 Previous illness – No
 Onset – 45 days
 Medical – No
 Surgical – No

Pain Assessment

 V.A.S – 9/10
 Type of pain – sensory
 Quality of pain – Sub- acute
 Aggravating fator- neck movement

Observation / Palpation

 Swelling – NO
 Redness –No
 Tenderness – No
 Temprature – Normal

Examination

~ R.O.M – Decreased with pain

~ M.M.T – Shoulder jt. – Rt.| Lt.

Flexor – 2/5|3/5

Extensor- 2/5|3/5

Elbow jt – Rt. |Lt.

Flexor - 3/5|3.5/5

Extensor – 3/5|3.5/5

Diagnosis – Cervical disc prolapse with nerve compression

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle tightness
 Increasing muscle strength

Treatment Plan

 IFT
 Hot pack
 Hold- relax
 Neck ROM and shoulder ROM
 US

Precautions / Home Advice

 Avoid extension and flexion of neck
 Take good diet
 Avoid cold water

CASE STUDY- 13

Demographic Details

Patient’s Name – Mehak

Hospital – Sitaram Bhartia Hospital

Weight – 72kg

Age/sex – 48/F

Chief complaint

I have abnormal cheek fat and altered fascial expression.

History

 Previous illness – No
 Onset – 18 months
 Medical – No
 Surgical – No

Pain Assessment

 V.A.S – 5/10
 Type of pain – sensory
 Quality of pain – Chronic

Observation / Palpation

 Swelling – NO
 Redness –No
 Tenderness – No
 Temprature – Normal

Examination

~ R.O.M – Neck ROM Decreased .

Diagnosis – Lateral deviation of the head to left with right fascial muscle weakness.

Goals

 Correcting expression.
 Increasing toning of cheek muscle

Treatment Plan

 Fascial stimulation
 Tapping
 Expression exercise
  Neck muscle release

Precautions / Home Advice

 Speaking Vowels
 Mirror talking
 Chewing gum

CASE STUDY - 12

Demographic Details

Patient’s Name – Kadhambani

Hospital – Sitaram Bhartia Hospital

Weight – 76kg

Age/sex – 50/F

Chief complaint - I have radiating pain in left arm along with tingling sensation.Point pain at
the buttock after a fall.

History

 Previous illness – Not known

 Onset – 3 weeks
 Medical – Diabetes ,hyperthyroidism
 Surgical - No
Pain Assessment

 V.A.S – 7/10
 Type of pain – sensory and muscular both
 Quality of pain – Sub- acute
 Aggravating fator- activity

Observation / Palpation

 Swelling – NO
 Redness –No
 Tenderness – No
 Temprature – Normal

Examination

~ R.O.M – Decreased with pain

Diagnosis – Coccydynia and left arm radiculopathy due to nerve compression.

Goals

 Decreasing pain
 Increasing ROM
 Decreasing muscle tightness
 Increasing muscle strength

Treatment Plan

 TENS
 Hot pack at shoulder
 Cold pack at buttock region
 SWD at left shoulder

Precautions / Home Advice

 Avoid jerky movements

 Avoid lifting heavy weights
 Take rest
 CASE STUDY- 11

Demographic Details

Patient’s Name – Chander Mohini

Hospital – Sitaram Bhartia Hospital

Weight – 72kg

Age/sex – 66/M

Chief complaint

I have pain in right hand and difficulty in performing daily life activities like combing hairs,
washing dishes and holding cup etc.

History

~ Previous illness – No

~ Onset – 3 months

~ Medical – No

~ Surgical – No

Pain Assessment

~ V.A.S – /10

~ Type of pain – sensory

~ Quality of pain – Sub- acute

~ Aggravating fator- Daily life activites

Observation / Palpation

~ Swelling – No
~ Redness –No

~ Tenderness – No

~ Temprature – Normal

Examination

~ R.O.M – Wrist extension decreased to 00

Diagnosis – Wrist drop of right hand due to right hand injury.

Goals

 Decreasing pain
 Increasing ROM
 Stretching of tightened muscle
 Increasing lengthen muscle strength
 Increasing sensation in the right hand

Treatment Plan

 Muscle stimulator (Surged faradic )

 Passive wrist ROM

Precautions / Home Advice

 Try to do wrists activities at home

 Avoid lifting heavy weights
 Self stretching of shortened muscles

CASE STUDY- 10
Demographic Details

Patient’s Name – Poornima Jha

Hospital – Sitaram Bhartia Hospital

Weight – 72kg

Age/sex – 32/F

Chief complaint

I am having weakness and pain in lower leg . Restlessness and difficulty in prolong walking.

History

~ Previous illness – No

~ Onset – 2 months

~ Medical – Hypothyroidism

~ Surgical – No

Pain Assessment

~ V.A.S – 9/10

~ Type of pain – sensory and muscular both

~ Quality of pain – Sub- acute

~ Aggravating fator- Prolong standing and walking and exertion.

Observation / Palpation

~ Swelling – Yes

~ Redness –No

~ Tenderness – Yes

~ Temprature – Normal

Examination

~ R.O.M – Restricted
~
M.M.T – Knee jt. – Rt.| Lt.
 Flexor – 2/5|2/5

Extensor- 2/5|2/5

Ankle jt. – Rt. | Lt.

Flexor-2/5|2/5

Extensor – 2/5|2/5

Hip jt – Rt. |Lt.

Flexor - 3/5|3.5/5

Extensor – 3/5|3.5/5

Adductor – 3/5|3/5

Abductor – 3/5|3/5

Diagnosis – Generalized nerve and muscular disorder

Goals

 Decreasing pain
 Increasing ROM
 Increasing muscle strength
 Correct posture

Treatment Plan

 IFT
 Musle stimulator(surged faradic current)
 Ultrasound
 Mild ROM
 Hot pack
 Gentle massage

Precautions / Home Advice

 Take rest
 Avoid exertion and jerking movements
  Avoid prolong standing
 Mild ROM
 Apply hot pack

CASE STUDY- 9

Demographic Details

Patient’s Name – Mrs. Tseringkee

Hospital – Sitaram Bhartia Hospital

Weight – 68kg

Age/sex – 58/F

Chief complaint

I have pain, discomfort and stiffness in whole body.

History

~ Previous illness – No

~ Onset – 4 months

~ Medical – No
~ Surgical – No

Pain Assessment

~ V.A.S – 9/10

~ Type of pain – sensory and muscular both

~ Quality of pain – Sub- acute

~ Aggravating fator- Daily activities

Observation / Palpation

~ Swelling – No

~ Redness –No

~ Tenderness – No

~ Temprature – Normal

Examination

~ R.O.M – Restricted
~
M.M.T – Knee jt. – Rt.| Lt.

Flexor – 2/5|2/5

Extensor- 2/5|2/5

Ankle jt. – Rt. | Lt.

Flexor-2/5|2/5

Extensor – 2/5|2/5

Hip jt – Rt. |Lt.

Flexor - 3/5|3.5/5

Extensor – 3/5|3.5/5

Adductor – 3/5|3/5

Abductor – 3/5|3/5
Diagnosis – Generalized nerve and muscular disorder

Goals

 Decreasing pain
 Increasing ROM
 Increasing muscle strength
 Correct posture

Treatment Plan

 IFT
 Musle stimulator(surged faradic current)
 Ultrasound
 Mild ROM
 Hot pack
 Gentle massage

Precautions / Home Advice

 Take rest
 Avoid exertion and jerking movements
 Avoid prolong standing
 Mild ROM
 Apply hot pack
 CASE STUDY- 8

DEMOGRAPHIC DETAILS

Patient’s Name- Shabnam Khan

Age/Sex- 23/F

Hospital- Sitaram Bhartia Hospital

Weight- 60kg

CHIEF COMPLAINT:-

 I have discomfort in the lower back

 I have pain while sleeping
 I have stiffness in lower back

HISTORY

 Previous illness- Nil

 Onset- Present form last 2 weeks
 Medical- Nil
 Surgical- Nil

PAIN ASSESSMENT

 V.A.S- 6
 Type of pain- Muscular
 Quality of Pain- Moderate pain

OBSERVATION/PALPATION

 Swelling- Absent
 Tenderness- Present
 Redness- Absent
  Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

DIAGNOSIS - Lumbago at L5-S1.

GOALS

 Decreasing Pain
 Increase Muscle strength
 Improve range

TREATMENT PLAN

 I.F.T
 Ultrasound at lower back
 S.W.D
 Warmup Exercise

PRECAUTION(s) & HOME ADVICE

 Rest
 Regular Exercise
 Avoid long standing
 Avoid bending forward

CASE STUDY- 7

DEMOGRAPHIC DETAILS

Patient’s Name - Driena Zelie Muca

Age/Sex - 14/F

Hospital – Sitaram Bhartia Hospital

Weight – 40kg

CHIEF COMPLAINT:-

 I have sharp pain in the right shoulder

 I have pain while sleeping
 I have stiffness around the shoulder

HISTORY

 Previous illness - No
 Onset - Present form last 3 months
 Medical – No
 Surgical - No

PAIN ASSESSMENT

 V.A.S - 5
 Type of pain - Radiating
 Quality of Pain - Moderate pain

OBSERVATION/PALPATION

 Swelling- Absent
 Tenderness- Present
 Redness- Absent
 Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

 MMT- Shoulder :- Flexion – 3+/5
Extension – 3+/5
Abduction – 3+/5
Adduction – 4+/5

DIAGNOSIS
  Trapezius muscle strain with nerve compression.

GOALS

 Decreasing Pain
 Correct posture
 Increase Muscle strength
 Correct mal-alignment

TREATMENT PLAN

 I.F.T
 Ultrasound at lower back
 Hot pack
 Warmup Exercise

PRECAUTION(s) & HOME ADVICE

 Bed rest
 Regular Exercise
 Avoid excessive movement of neck
 Keep correct posture
 Avoid regular use of phone or using whatsapp

CASE STUDY- 6

DEMOGRAPHIC DETAILS

Patient’s Name - Aayan

Age/Sex - 35/F

Hospital – Sitaram Bhartia Hospital

Weight – 75kg

CHIEF COMPLAINT:-

 I find difficulty in changing posture from sitting to standing

 I have pain while sleeping
 Stiffness in the back

HISTORY
  Previous illness - No
 Onset- Present form last 4 months
 Medical- Nil
 Surgical- Nil

PAIN ASSESSMENT

 V.A.S- 7
 Type of pain- Muscular
 Quality of Pain- Quite severe

OBSERVATION/PALPATION

 Swelling- Absent
 Tenderness- Present
 Redness- Absent
 Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

 MMT- Shoulder :- Flexion – 3+/5
Extension – 3+/5
Abduction – 3+/5
Adduction – 4+/5

DIAGNOSIS

 Benign paroxysmal positional vertigo along with muscle tightness.

GOALS

 Decreasing Pain
 Decrease vertigo
 Decrease tightness
 Increase range of motion
 Increase muscle strength

TREATMENT PLAN

 I.F.T
  Ultrasound at lower back
 Laser
 Warmup Exercise

PRECAUTION(s) & HOME ADVICE

 Bed rest
 Hot Pack (morning & evening)
 Avoid lifting heavy weights
 Keep correct posture

CASE STUDY- 5

DEMOGRAPHIC DETAILS

Patient’s Name - Rohan

Age/Sex - 16/M

Hospital- Sitaram Bhartia Hospital

Weight – 45kg

CHIEF COMPLAINT:-

 I have difficulty in knee bending

 I can’t able to do sports activity
 Due to pain I reduced my daily activity

HISTORY

Previous illness- No

Onset- Present form last 1 year

Medical- Nil

Surgical- Nil

PAIN ASSESSMENT

 V.A.S- 8
  Type of pain- Joint
 Quality of Pain- Severe

OBSERVATION/PALPATION

 Swelling- Present
 Tenderness- Present
 Redness- Absent
 Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

 MMT- Knee (Both legs):- Flexion- 3/5, Extension – 3/5

DIAGNOSIS

 Osgood Schlitter syndrome.

GOALS

 Decreasing Pain
 Increase muscle strength
 Improvise aggravating activity
 Increase range of motion

TREATMENT PLAN

 I.F.T
 Tens
 Ultrasound
 Laser

PRECAUTION(s) & HOME ADVICE

 Bed rest
 Avoid playing
 Avoid aggressive activity
 CASE STUDY- 4

DEMOGRAPHIC DETAILS

Patient’s Name - Divya Bhatia

Age/Sex- 17/F

Hospital- Sitaram Bhartia Hospital

Weight- 42kg

CHIEF COMPLAINT:-

 Patient complains of back pain specially in sitting

 Morning stiffness
 Decrease back mobility
 Difficulty in standing with walking for long

HISTORY

 Previous illness- No
 Onset- Present form last 8 Months
 Medical- Nil
 Surgical- Nil

PAIN ASSESSMENT

 V.A.S- 6
 Type of pain- Muscular
 Quality of Pain- Moderate pain

OBSERVATION/PALPATION

 Swelling- Absent
 Tenderness- Present
 Redness- Absent
 Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

  MMT-
Knee (Both legs):- Flexion – 3/5
Extension – 3/5
Ankle (Both legs):- Flexion – 3/5
Extension – 3/5
Eversion – 3/5
Inversion – 3/5

DIAGNOSIS - Lower Back Ache with muscle weakness.

GOALS

 Decreasing Pain
 Increase muscle strength
 Improvise aggravating activity
 Increase range of motion

TREATMENT PLAN

 I.F.T + hot pack

 Exercises
 Leg release

PRECAUTION(s) & HOME ADVICE

 Bed rest and take side turn and then get up from the bed
 Avoid forward bending
 Avoid aggressive activity
 Avoid lifting heavy weights

CASE STUDY- 3

DEMOGRAPHIC DETAILS

Patient’s Name - Cap. Aggarwal

Age/Sex- 74/M

Hospital- Sitaram Bhartia Hospital

Weight- 80kg

CHIEF COMPLAINT:-
  I have pain on the left to right hip region.
 The pain is more on sitting for prolong hours.

HISTORY

 Previous illness- No
 Onset- Present form last 15 Months
 Medical- Nil
 Surgical- Nil

PAIN ASSESSMENT

 V.A.S- 4
 Type of pain- Muscular
 Quality of Pain- Mild pain

OBSERVATION/PALPATION

 Swelling- Absent
 Tenderness- Present
 Redness- Absent
 Temperature- Normal

EXAMINATION

 R.O.M- Decreased Range of Motion

 MMT-Knee (Both legs):- Flexion – 3/5
Extension – 3/5

DIAGNOSIS

 Gluteal Bursitis with muscle tightness.

GOALS

 Decreasing Pain
 Decrease muscle tightness
 Increase flexibility
 Increase range of motion

TREATMENT PLAN
  I.F.T
 Ultrasound
 Ankle releases
 Laser

PRECAUTION(s) & HOME ADVICE

 Rest
 Avoid excessive movement
 Avoid prolong standing

CASE STUDY- 2

Demographic Details

Name- Anju sood

Age/Sex- 28/F

Occupation- house wife

Hospital- Sitaram Bhartia Hospital

Chief Complaint

 Pain in fifth toe.

 walking is restricted.
 no movment at metatarsals.
 Weak Dorsi and plantar flexion.

History

 Previous illness- No
 Medical- No
 surgical - No surgical history.
Pain Assessment

 VAS - 6/10
 Type of pain- Muscular
 Quality of pain- sub acute

Observation/ palpation

 Swelling- present
 Redness- absent
 Temperature- present
 Tenderness- present

Examination

R.o.m- Restricted

Rt/Lt

M.M.T- Ankle- 2/5

Dorsiflexion-2/5

Plantarflexion-2/5

Diagnosis-Fracture at fifth toe (lt)

Goals

 Decrease pain
 Gain muscles strength
 Gain range of motion
 Increase mobility

Treatment plan

 contrast bath
 Ultrasound
 Exercise-hams, calf and adductor stretching.
 Tens- in calf(2p) and fifth toe(2p).

Precaution/ Home advices

 Apply oil over that region.

  Do not massage with oil.
 Avoid prolong standing.
 Do exercise at home every exercise for 10 min. 2 times in a day after taking proper meal.
 Avoid exertion.

CASE STUDY - 1

Demographic Details

Name- Rohan

Age/sex - 23/M

Occupation- student

Hospital- Sitaram Bhartia Hospital

Chief Complaint

 Pain at metacarpal
 wrist stiffness due to fracture
 weakness of little finger (Lt)

History

 Previous illness- No
 Medical- No
 surgical - No surgical history.

Pain Assessment

 VAS - 4/10
 Type of pain- Muscular
 Quality of pain- acute

Observation/ palpation

Swelling- absent

Redness- absent

Temperature- absent

Tenderness- present
Examination

ROM- mild Restricted

M.M.T- Rt/Lt

Wrist movements -4/5

Finger flexion- 3/5

Finger Extension- 3/5

Diagnosis- Fracture of little finger

Goals-

 Decrease pain
 Gain muscles strength
 Gain range of motion
 Increase mobility

Treatment plan

 Hot pack at wrist and metacarpal phelengeal

 Ultrasound at wrist
 Exercise- ,wrist and metacarpal joint movements

Precaution/ Home advices

 Rest and hot pack

 Do exercise at home every exercise for 10 min 2 times in a day after taking proper meal,
Avoid lifting heavy weights and Avoid exertion.