1Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What diagnosis is this consistent with?
subacromial impingement
2Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What structures are involved?
Supraspinatus muscle, Subacromial Bursa, Subdeltoid Bursa
3Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What effect will this condition have on occupations?
Getting Dressed, Reaching for things overhead, Working (involves a lot of overhead reaching)
4Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
How would this affect your OT evaluation and treatment?
AROM, MMT, goniometry
Limit overhead motion
5Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What are some precautions the OT must be aware of prior to completing the evaluation?
Shoulder pain
Repetitive motion
6Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
Contraindications?
n/a Precaution - not to exacerbate injury, lead to rotator cuff tear
7Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What measurements would we assess?
AROM? - yes
PROM? - no unless needed
MMT? - yes
8Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
List two activities to include in Jamil’s care
Scapula retraction, ER of shoulder, light activity to promote shoulder AROM, limited repetition
9Case 1: Jamil is a 45-year-old male referred to outpatient occupational therapy services secondary to L shoulder pain. Jamil is an electrician that frequently installs wiring and ceiling fixtures overhead in residential homes. He c/o a pinching pain when raising his arm overhead that worsens the more he works. The pain began after working a 12-hour shift with no reported fall or trauma. The occupational therapist is completing the initial evaluation. The physician’s orders are: OT or PT eval and treat L shoulder pain
What activities or occupations may cause or aggravate shoulder impingement?
Overhead stress
Hanging clothes in closet
Installing wiring and ceiling fixtures
10Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
What structures are involved?
Left Shoulder
Left scapula
11Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
What effect will this condition have on occupations?
ADLs
IADLs
health management
rest and sleep
work
12Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
How would this affect your OT evaluation and treatment?
Less resistance for MMT
Low weight bearing
13Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
What are some precautions the OT must be aware of prior to completing the evaluation?
Arthritis
Pain
Cardiac precautions
cancers
14Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
Contraindications?
DVT
Bone Metastases
Weight Bearing restrictions
15Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
What measurements would we assess?
AROM? Yes, but patient may not be able to achieve full ROM
PROM? No
MMT? We could do this but you would need to reduce the subluxation with position
16Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
List two activities to include in Shantel’s care
Strengthening of shoulder muscles
Low resistance Therabands to work on strengthening
17Case 2: Shantel is a 45-year-old female referred to outpatient occupational therapy secondary to a CVA with resulting L hemiparesis. Shantel received intensive OT, PT, and SLP for 2 weeks in an inpatient rehabilitation hospital. Upon evaluation, Shantel c/o L shoulder pain and the occupational therapist palpated a 1 finger width shoulder subluxation.
How can shoulder subluxation be prevented in a client with a CVA?
Limiting overheard motion
Strengthening shoulder muscles
Avoid lifting heavy objects
18Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
What structures are involved?
Glenerohumeral joint
19Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
What effect will this condition have on occupations?
Reach in cabinet, overhead dressing
20Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
How would this affect your OT evaluation and treatment?
No goniometry, no passive mmt
21Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
Contraindications?
Advanced stage of osteoarthritis
22Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
What measurements would we assess?
AROM?
PROM?
None
MMT?
Only activities under 90 degrees
23Case 3: Mabel is an 83-year-old female referred to OT for “improve ADLs” secondary to advanced stage bilateral shoulder osteoarthritis. Mabel reports no pain in her shoulders but feels a “grinding sensation and a hard stopping point if she lifts her arms over shoulder height”
List two activities to include in Mabel’s care
Teach her adaptive technology to reach overhead
Loose packed positions to help stretch her shoulder