Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Pain Rehabilitation; Measurement
Objective : To identify ways to improve clinical, diagnostic, and predictive reasoning in patients with shoulder osteoarthritis (OA).
Design : A Retrospective Case Study. Patient was initially evaluated and treated by an orthopedic PT(OPT) for a period of 4 months. Additionally the patient consulted an Orthopedic Certified Specialist (OCS) in two occasions 6 and 10 weeks.
Setting : Outpatient Physical Therapy Practice
Participants (or Animals, Specimens, Cadavers) : A 63 year-old male dentist with right shoulder impingement, calcific tendonitis, acromial bone spur, and 2-year history of pain, weakness, stiffness, and difficulty with functional activities.
Interventions : Patient was treated by an orthopedic PT(OPT) 2-3X/week for 4 months with hot packs, ultrasound with biofreeze, electrical stimulation, laser therapy, kinesiotaping, Grade I and II joint mobilization, myofascial release, Graston, effleurage, stretching and strengthening exercises.
Main Outcome Measure(s) : Patient was re-assessd by an Orthopedic Certified Specialist (OCS) on two occasions 6 and 10 weeks. Arthokinematic, Ostekinematic, Pain, Perception Based Outcome Questionaires and Special Tests of Right shoulder were included in patient's evaluaion.
Results : Pre-post examinations by OPT and OCS showed no improvement in patient status except for 20 flexion/abduction. Clinical reasoning by OPT was consistent with diagnosis and treatment of impingement syndrome while OCS exam findings were for joint congruity issue. An orthopedist found joint incongruity on exam and MRI confirmed a B2 Glenoid. The patient underwent a reverse total shoulder replacement several months later.
Conclusions : Limitations in ROM and bony end-feels for horizontal abduction/adduction, internal/external rotation, and special test results conducted by OCS suggested articular incongruity and possible rotator cuff tear. There is a need for clinical prediction rules to guide PTs in determining OA and joint congruity issues that are less likely to respond to PT treatment.