CASE STUDY OF SHOULDER PAIN PATIENT

BY :SOBIA JAVED
M.PHIL. 1ST SEMESTER

EBP ASSIGNMENT
CLINICAL QUESTION (ASK)

• A 43 year old police officer presented in the clinic with a one week history of right shoulder pain. It is
important to undertake a thorough assessment involving questions and physical tests to determine the
best way to treat a problem.
SEARCH & HISTORY

• The patient explained that his pain started when he woke up one morning. He had also noticed, “a
strange feeling” in his middle two fingers that came and went with no pattern. He did not recall
straining his shoulder and had not undertaking any strenuous lifting. He had no other health complaints
and was a keen runner. His pain was worse at night. His pain was brought on when he raised his arms
above his head and eased as soon as he stopped the painful movement.
SEARCH & HISTORY

• Daily pattern – No pattern, the problem was dependent on activity

• Past medical history – Nothing significant
• Medication – Not taking any at present
• Social History – Lives at home with his wife and two children
APPRAISE

Observation
• On examination he presented with generally good posture and muscle tone. He had no pain at rest.
Movement
• On movement he had pain on raising his arm in front of him and to the side when the arm reached
shoulder level.
APPRAISE

Muscles
• All local shoulder muscles tested strong. There was some tightness in the pectoral's minor muscle at
the front of his chest and his scalene muscles (muscles on the side of the neck) on the right were tight.
Nerve movement
• There was some restriction of nerve movement in the arm.
Joints
• The shoulder joint did not appear restricted however the lower neck joints were stiff and the first rib on
the right was elevated.
INTEGRATE

Impression
• My initial thoughts were that this gentleman’s problem came from stiffness in the neck and restricted
movement of his first rib, (probably due to the tight muscles in the neck!). This in turn was restricting
how the nerves moved as they run from the neck down the right arm. This was causing the “strange
feeling” in the fingers.
Treatment
• I discussed the presentation with the patient to ensure he had a good understanding of the problem
and the likely outcome of treatment. I mobilized the neck joints and the rib. This brought about
increased movement before pain started. Pain was now experienced when the arm was above his head
as opposed to at shoulder level
EVALUATE

Outcome
• He was seen three times over two weeks and his shoulder pain ceased. He had good movement and
good length of the muscles in the neck and chest. The nerves were moving better and the “strange
sensation” in the fingers had gone. Three weeks later he phoned complaining of the same symptoms.
This time he explained that he had been lying on his left side for long periods, on the couch watching TV
with his head tilted to the right. The treatment was repeated over two sessions and the symptoms
cleared. Following this episode of treatment he was advised to not lay for long periods with his head to
the side as this was seen to be shortening the muscles on the right side of the neck and therefore
pulling on the ribs and neck joints and triggering the symptoms
EVALUATE

Thoughts
• It is important to identify and address the underlying problems as well as treating the symptoms that
present in the clinic to bring about long term solutions to problems. It is also important to note that
the area that you feel pain in is not always the area that is causing the pain