Self-analysis materials (e.g., photos, charts, study reports to interpret, questions to think about etc.)

A 70-year-old, blind female patient presents with right shoulder pain. 

Her anamnesis revealed that she had had left shoulder pain for 6 months and that her upper arm was numb, so she consulted a rheumatologist. The doctor found no significant difference that could be confirmed by imaging. She was treated with medication (non-steroidal anti-inflammatory drugs) and physiotherapy, and later her symptoms largely disappeared. Since then, she has had occasional pain, especially when he raises her arm, but it does not interfere with her daily life. 

Now she has pain in her right shoulder, especially at work, and she is afraid it will get worse. 

When asked, she says that she has used her left upper extremity less since the earlier symptoms. 

Other information: she does not exercise much due to visual impairment, has a negative mammogram and has not been in an accident. 

Have a look at the video below ( Video 1.) and observe what you see on the patient? 

In the case of painful arch syndrome, the movement is as follows. (Video 2.) During the movement, the patient reports pain in both shoulders. In the left shoulder, from a range of 140-150°, which she rates as a 3. In the right shoulder, in the middle range, she also rates this as a 3. 

The empty can test performed on the right side can be performed, but when resistance is applied the patient’s pain increases (score 4-5) and then decreases after the test. 

The Apley scratch test (Video 3) shows the following. 

During the scapular retraction test, the pain appears to be less (she rates it as 2). (Video 4) 

In the case of the lateral scapular sliding test, the following is seen. (Video 5) 

In the lady’s case, there is no need to consult another specialist, there are no contraindications, and further investigation and treatment planning can begin. 

The position of the shoulder girdle and shoulder blades has changed due to the lady’s posture. The left shoulder problem is followed by symptoms of overuse of the right shoulder. Due to the underuse of the left shoulder, the muscle contour in the shoulder girdle-shoulder area is more flattened, and ROM restriction at the end of the range of motion is visible. Full abduction was not performed or was performed with a flexion compensated movement pattern. 

Aim: To correct posture as much as possible, to strengthen the scapular stabilising muscles, to strengthen the shoulder muscles, especially the deltoid and rotator cuff muscles, to examine and stretch shortened muscles. Once the shoulder-shoulder-neck-back mobilisation has been completed, it is worth extending the therapy to the pelvic-lumbar region.  Warm up, active exercises, soft tissue techniques, myofascial release, deep massage, dynamic stabilisation with PNF and functional stabilisation (with bands, dumbbells, closed chain exercises, neurodynamic treatment, postural sensing and correction exercises), body awareness, posture corrections.