PPD3

Question 1

Subacromial Pain Syndrome Assessment

Answer 1

Assessment:

1. Passive ROM:

• Expected to find painful arc during shoulder abduction (typically 60-120°) due to compression of subacromial structures
• Limitation in passive elevation and external rotation may be present due to pain inhibition

2. Active ROM:

• Painful arc/ weakness during active abduction and forward flexion
• Possible scapular dyskinesis
• Compensatory movement patterns (excessive shoulder elevation, scapular winging)

3. Palpation:

• Tenderness over the anterolateral aspect of the acromion
• Potential tenderness over the supraspinatus and/or infraspinatus tendon insertions
  1. Strength testing

Expect reduced strength in abduction, flexion

Specialized Assessments:

Neer’s Impingement Test:

• Arm fully pronated, forced into forward flexion to compress the subacromial space
• Positive if pain reproduced in the anterior/lateral shoulder

Hawkins-Kennedy Test:

• Shoulder and elbow flexed to 90°, then shoulder internally rotated
• Positive if pain reproduced, indicating impingement of the rotator cuff tendons

Empty Can Test (Jobe’s Test):

• Arms at 90° abduction, 30° forward of the frontal plane, thumbs pointing down
• Positive if weakness or pain during resistance, suggesting supraspinatus involvement

OM: DASH, Muscle strength testing, NPRS

Question 2

Subacromial pain Treatment

Answer 2

Treatment:

Manual Therapy:

• Posterior capsule mobilization to improve external rotation
• Glenohumeral joint mobilization (grades I-II for pain; III-IV for stiffness)
• Soft tissue mobilization to upper trapezius, levator scapulae, and infraspinatus

Exercise:

• Rotator cuff strengthening:
  
  • External rotation with resistance band starting at side
  • Internal rotation with resistance band
  • Prone horizontal abduction (focusing on external rotation)
  • Progression to functional diagonal patterns
• Towel walk up the wall, flexion and abduction
• Push ups against the wall

Education:

• Explain the pathology: Compression of structures in the subacromial space during overhead activities
• Activity modification to avoid painful arc during the acute phase
• Workspace ergonomics to reduce overhead reaching and inappropriate loading

Question 3

Osteoartheritis Assessment and OM

Answer 3

Assessment:

Passive ROM: Expected to be reduced due to patient pain as cartilage has reduced causing bone on bone friction causing pain and limiting joint movement - Friction between the nerves in the periosteum

Active ROM: Pain and decreased joint mobility can lead to muscle weakness around the affected joint, further limiting active ROM.

Palpation: Joint Line tenderness

Specialised Assessments:

Hip OA: FABER /FADIR - Expect Reduced Internal rotation / Pain

Outcome Measures:

Timed up and go test followed by NPRS

Internal Rotation whilst in supine lying 90 degrees flexion

Question 4

Osteoarthritis Treatment Hip/Knee

Answer 4

Treatment:

Exercise:
Hip:

Leg Swings - Dynamic Warm up

Calmshells - Progression to exercise bands, then leg lifted off the floor

Half Squats - Progression to Full squats

Knee:

Seated knee flex/extension with towel under the foot

Knee extension in sitting

Knee flexion in prone

Half squats - progression to full squats

Lunges

Manual therapy

Knee - patella mobs

Education:

Explain the pathology: Morning stiffness is due to the unhealthy joint not producing ample synovial fluid during the night. Increasing movement Increases fluid

Obesity:- Increases stress on the joint and unhealthy eating reduces the nutrients going to the joint

Myth: Osteoarthritis is NOT wear and tear and increasing the amount of movement is a good thing. Walking Approximately 6,000 steps a day has been proven to improve osteoarthritis

References Required: Nice guidelines to OA Management, Exercise therapy guidelines (prescription),

Question 5

Lateral/Medial tendinopothy Assessment

Answer 5

Assessment:
1. PROM:

Expected to be preserved but potentially painful at end ranges
Pain with passive wrist flexion and pronation (medial tendinopathy)
Pain with passive wrist extension and supination (lateral tendinopathy)
Potential for restricted elbow extension if chronic

2. Palpation:

Point tenderness over medial epicondyle and common flexor tendon origin (medial tendinopathy)
Point tenderness over lateral epicondyle and common extensor tendon origin (lateral tendinopathy)
Possible increased tone in forearm musculature on affected side

3. Strength Testing:

Weakness and pain with resisted wrist flexion and pronation (medial tendinopathy)
Weakness and pain with resisted wrist extension and supination (lateral tendinopathy)
Pain typically reproduced with grip strength testing
Possible weakness in grip strength due to pain inhibition

Specialized Assessments:
Golfer’s Elbow Test (Medial):

Elbow extended, forearm pronated, wrist flexed
Positive if pain increases with resisted wrist flexion

Cozen’s Test (Lateral):

Elbow extended, forearm pronated, wrist extended
Positive if pain increases with resisted wrist extension

Mill’s Test (Lateral):

Elbow extended, forearm pronated, wrist and fingers flexed
Examiner applies overpressure into wrist flexion
Positive if pain at lateral epicondyle

Question 6

Elbow tendinopathy