Relationship of symptoms P1=P2
¬¬¬¬ Clinical reasoning
Suspected source of symptoms:
P1- Acromioclavicular joint, glenohumeral joint, rotator cuff muscles and cervical spine.
P2- Glenohumeral joint, rotator cuff muscles, scapulae, cervical spine
Early hypothesis: rotator cuff pathology, muscle strain, articular joint problem, osteoarthritis.
Patient does not complain sharp or shooting pain that indicate nerve root involvement (Magee 1997, Newham & Mills 1999).
This patient complain of constant dull ache and nagging pain that indicate muscle and bone involvement (Magee 1997, Newham & Mills 1999).
All symptoms are intermittent which suggests a mechanical nociceptive pain.
Relationship of symptoms …show more content…
-P1 take 10 minutes to disappear
-P2 take 2 minutes to disappear
Irritable. If the symptom take few minutes to disappear, it considered irritable (Petty, 2011).
24-hour behavior
• Intermittent pain on the day dependent on activity.
• Patient have increase pain at night but did not disturb his sleep. • Pain that increases with activity may be due to repeated mechanical stress, an inflammatory process or degenerative process (Jull, 1986).
• Night pain is common for patient with adhesive capsulitis (Iannoti, 2013)
Special question
None of note. No precaution or contraindications.
History of present condition (HPC)
Gradual onset of pain at P1 3 month ago after playing badminton. Pain become severe and P2 present with P1 3 weeks ago. Patient unable to fully lift up his right shoulder. Patient went to see doctor and given pain killers. Patient unable to continue his hobby of playing badminton and the pain disturbing his occupation. Patient develop pain after intense activity. Patient pain is insidious and increase in severity which mean the prognosis is not good.
Provides supporting evidence that all the symptoms are related.
Past medical …show more content…
The nature of work may effect patient’s prognosis. Plan of physical examination
The relationship of symptoms, history of present condition and aggravating factors suggested that there is a single source of symptoms. This, together with the body chart, would implicate the cervical spine. However, the aggravating factors for cervical spine were negatives. Therefore, when examining the cervical spine it will be necessary to use combined movements.
The aggravating factors, together with the body chart, implicates the shoulder region and shoulder’s muscles as a source of symptoms.
Although the aggravating factors could also implicated the thoracic spine, the area of symptoms, P1+P2 and the relationship of symptoms negates this as a source.
The plan for day 1 therefore examine fully the shoulder, muscle surround it and cervical spine. Clearing the thoracic spine is not a priority.
Patient does not complain sharp or shooting pain that indicate nerve root involvement (Magee 1997, Newham & Mills 1999).
This patient complain of constant dull ache and nagging pain that indicate muscle and bone involvement (Magee 1997, Newham & Mills 1999).
OBJECTIVE ASESSMENT
Physical