Case Study – SLAP Lesion

February 5, 2019 | By | Reply READ MORE...

WILL I BE ABLE TO LIFT MY ARM???
Mrs X, 59 year old female, self employed having a desk job of 4-5 hours, came to PHYSIOREHAB with a complaint of left arm pain since 12 days after she overstretched her arm against the wall while showing somebody an exercise repeatedly, and her leg slipped and hit the wall while the arm got overstretched.
Has difficulty in overhead activities, in basic activities like grooming and upper body bathing and complaints of disturbed sleep at night.

PATIENT HISTORY :-
Patient was advised to go to an Orthopaedic Doctor for further evaluation, after which she was asked to get an MRI scan of shoulder. She was advised rest for 6 weeks as she was diagnosed with a fracture, post which rehabilitation was started.

INVESTIGATION :-

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  • No significant medical History Reports
  • Vit D3 and B12: normal
  • MRI of shoulder:
    – A two part fracture extending from the head of the humerus involving the tuberosity and upper shaft.
    – A partial thickness tear of the supraspinatus tendon
    – Mild degeneration changes in the acromio-clavicular joint.
    – Tear of the anterior and postero-superior glenoid labrum.
  • Bone Mass Density – -2.6

ON OBSERVATION :-

  • Forward head
  • Rounded shoulders
  • Left shoulder dropped
  • Decreased thoracic kyphosis

ON EVALUATION :-

  • Shoulder ROM
    Active – Flexion – 80
    – Abduction – 70
    – Extension – Full
    – IR – 50
    Passive – Flexion – 120
    – Abduction – 110
    – Extension – Full
    – IR – ERP
  • Cervical spine ROM – mid cervical translation, End range right rotation restricted.
  • Decreased dorsal spine mobility
  • Right side thoracic rotation restricted
  • Triggers in deltoid and trapezius
  • Load shift test – to assess the stability of the glenohumeral joint.
  • Empty can test – to assess supraspinatus muscle and tendon.

PATIENT’S GOAL :-

  • To be able to perform all the activities of daily living. Especially grooming.

THERAPIST’S GOALS :-

  • To relieve pain
  • To increase shoulder range of motion
  • To Improve muscle strength

The Rehabilitation Programme includes :-

1) Conservative treatment of glenohumeral fracture
6 weeks of immobilization of the shoulder joint in a sling as conservative fracture management.

2) Pain Management :
Electrotherapy and taping to reduce her shoulder pain.

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3) Scapula stability exercises :
Anteriorly tilted and downwardly rotated scapula impinges on the rotator cuff risking their tear and that’s why it’s important to train the scapular muscles in this case. Exercises to correct the shoulder blade position and maintain a correct posture which in turn helps in improving the co-ordination between the shoulder and shoulder blade during arm movements.

4) Dorsal spine mobility :
Office Exercises and stretches to increase mobility of dorsal spine.

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5) Soft Tissue Release of tight muscles :
Myofascial release for the tight pectoral and serratus anterior muscles to open up the capsule and furthermore increase the range of motion.

6) Shoulder mobility exercises :
Cane Exercises were used to improve flexion,abduction,IR range of motion of the shoulder joint.

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7) Strengthening :
Theraband exercises to improve strength of the shoulder and scapular muscles.

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8) Proprioception of shoulder :
Exercises to improve proprioception of shoulder were included after achieving good control of scapular muscles.

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OUTCOME :
Within 12-14 weeks of physiotherapy, the Disability of arm, shoulder and hand (DASH) scale scored 48/100 to 16/100 , which indicates the lesser the total score, lesser the disability.
She felt more confident in doing her overhead activities and daily activities. Also, she could comfortably sleep well at night.

CONCLUSION :
Mrs X 59 year old was diagnosed with a superior labral tear from anterior to posterior (SLAP) lesion with glenohumeral fracture and we at PHYSIOREHAB always treat a patient as a whole and design a program which is specific to the cause of the symptoms, along with having a baseline of the DASH scale as our marker for improvement.

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Category: Case Studies

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