by Nick Kossor, PT, DPT
Physical Therapy Case Study For Calcific Tendonitis Developed d/t Shoulder Instability
History
A 46-year-old male entered the clinic with complaints of intermittent right shoulder pain. The pain gradually intensified over a period of months with no specific mechanism of injury. The patient mentioned symptoms became worse and worse with playing fetch with his dog. Currently, aggravating factors include donning/doffing jackets and reaching with the right arm.
Evaluation
Objective measurements of passive range of motion were within normal limits in all planes and pain free. The patient reported pain with active shoulder flexion but there was no compromise to active range of motion in any plane. Special tests for rotator cuff tears were all negative. Various special tests for labral tears were all positive including: apprehension, Crank, Obrien.
Treatment
Visit 1: Education on the anatomy of the GH joint and the rehab process for treating shoulder instability was provided. Basic external and internal rotator cuff exercises were prescribed to help keep the head of the humerus in the center of the glenoid. Manual therapy and soft tissue work was performed on muscles in the cervical, and scapular region that have been overactive due to shoulder instability. Other interventions focused on optimizing scapula-humeral rhythm, specifically targeting the muscles responsible for scapular upward rotation.
Visit 2: Therapist made sure all home exercises were performed with proper technique. Rotator cuff and stabilizing interventions were progressed to greater difficulty. Manual therapy interventions remained the same.
Visit 3: After laying a foundation of home exercises and proper exercise technique, iontophoresis to the long head of the bicep was applied to address calcified build up. Subjective and objective measures including insidious onset, point tenderness, pain with active shoulder elevation, throbbing pain at rest regardless on position, and negative rotator cuff special tests warranted use of iontophoresis to treat calcific tendonitis of the bicep.
Visit 4: Patient reported significant reduction of shoulder symptoms overall. He was no longer in throbbing pain at rest and only noticed shoulder discomfort after longer walks with his dog. Rotator cuff strengthening and stability interventions were maintained at their current intensity. Iontophoresis was applied at the end of the session.
Visit 5: Patient reported continued improvements in symptoms. Strengthening and stability interventions were progressed. Manual therapy remained the same. Iontophoresis was applied at the end of the session.
Visit 6: By the 6th session, the patient demonstrated improved stability of the shoulder with overhead and throwing motions. Improved neuromuscular control of the scapular upward rotators was evidenced during therapeutic interventions.
Visit 7: Patient reported complete alleviation of shoulder pain at rest and with activity. The patient was educated on discharge planning and how to continue shoulder interventions/exercises at home.
Visit 8: Based on subjective and objective measures, the patient was discharged. SPADI scores went from a 47% disability from visit 1 to a 0% disability 1 month later.
6-month Follow Up:
Patient reported 0/10 shoulder pain at rest and with activity. He is able to walk his dog pain free.
Read More Physical Therapy Case Studies from Capital Area Physical Therapy.
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