Question

History: John is a 22 year old student that has been experiencing increased problems with his left shoulder over the last 4 weeks. The problem began with a sharp twinging pain over the deltoid region while working shelf stacking in the library. The symptoms have now worsened to a constant ache and are made worse by racquet sports and overhead activities at the gym. He has difficulty sleeping due to night pain. The only thing that makes it better is avoiding those motions and resting. He lives with his parents and younger brother and sister who are both of school age. He is otherwise fit and well and takes no medications.

a. What would you suspect his RROM to be?

b. What would you suspect his PROM to be? There is crepitus with ROM of the shoulder. You proceed with special tests and determine that he is positive for the following tests… • Hawkins-Kennedy • Empty Can • Drop Arm Test – no smooth eccentric contraction of arm from abduction (drops in middle 60 degrees)

c. What is your differential diagnosis and why? (List 3 possible conditions)

Please answer all.

Answer 1

a)with the help of (muscle manual training) MMT we can score a patient's range of motion. RROM(resistive range of motion) of this client can be painful as he has complained of shoulder pain. He can't tolerate resistance so the score can be 3.

b) PROM( passive range of motion) of the client will also be a painful and not visible palpable contraction.

c) having tested positive of all these three tests indicates a shoulder injury. And tendon damage. As positive Hawkins-Kennedy test proves damage to the tendon of the supraspinatus muscle. Same as with empty can test. However, having pain between 60° and 120° proves subacromial pain or rotator cuff disorder.

Differential diagnosis can be-

1)rotator cuff tendinopathy

2) acromioclavicular injury

3) bursitis