Event Title

Physical Therapy Interventions in a 40-Year-Old Female with Acute Left Shoulder Traction Injury: A Retrospective Case Report

Author/ Authors/ Presenter/ Presenters/ Panelists:

Saural Bhatt, Governors State UniversityFollow

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Virtual Poster Session

Abstract

Background and Purpose: A brachial plexus injury (BPI) is a severe peripheral nerve injury that affects the upper extremities (UE) and can cause functional impairment and physical disability. Based on the level of lesion, clinical manifestations could be localized to the shoulder, or may impact the entire ipsilateral UE. Impairments can include decreased mobility, strength, and sensation as well as pain. The purposes of this retrospective case report were two-fold. First was to investigate the impact of conservative treatments on pain and functional limitations of a 40-year-old female with an acute shoulder injury. Second was to differentiate whether the patient’s symptoms were primarily due to traumatic nerve injury, musculoskeletal injury, or other factors.

Case description: A 40-year-old female referred to an outpatient (OP) physical therapy (PT) for L shoulder pain and radiating symptoms began after getting involved in a scuffle with a motorist who pulled her L arm vigorously. The initial symptoms indicated more of a nerve traction injury than musculoskeletal damage. The intervention included manual techniques, therapeutic exercises to improve shoulder mobility, pain management and postural exercises. Self-reported outcome measures and functional outcome measures (UEFI, NPRS) were utilized to assess improvements.

Outcomes: The intervention caused no adverse effects to the patient’s condition. Throughout the Plan of Care, significant improvement was noted in shoulder mobility (AROM and PROM); UEFI improved from 15/80 to 35/80; pain intensity on NPRS decreased (worse pain from 7/10 to 5/10; best pain level from 2/10 to 1/10; at rest from 5/10 to 2/10); Manual Muscle Testing showed significant improvements in all L shoulder muscle groups.

Discussion: The musculoskeletal treatment approach was safe and appeared to be beneficial for addressing the L shoulder injury. Overall, symptoms originally suggested a potential BPI. However, based on improvement and recovery time while in physical therapy, the injury appeared to be more musculoskeletal than neurological in nature. Considering the time typically required for recovery of BPI, the POC would have been different if the patient had a confirmed BPI. This case report may be useful for tailoring interventions to patients with similar shoulder injuries. Additionally, future study should consider investigating the addition of a digital app based HEP and impact on patient’s use of HEP as well as efficacy of dry needling to help eliminate pain and tenderness. For clinical judgement, electromyography initially would have helped to determined differential diagnosis considering the mechanism of injury.

Keywords: Shoulder traction injury (musculoskeletal injury or BPI), soft tissue mobilization, ROM exercises, therapeutic exercises."

Presenter:
Saural Bhatt
Physical Therapy Doctoral Student

Faculty / Staff Sponsor

Dr. Roberta K. O'Shea
Professor, College of Health and Human Services

Patricia O’Brien
Adjunct Faculty Member, College of Health and Human Services

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PT Poster - Saural Bhatt

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Physical Therapy Interventions in a 40-Year-Old Female with Acute Left Shoulder Traction Injury: A Retrospective Case Report

Virtual Poster Session

Background and Purpose: A brachial plexus injury (BPI) is a severe peripheral nerve injury that affects the upper extremities (UE) and can cause functional impairment and physical disability. Based on the level of lesion, clinical manifestations could be localized to the shoulder, or may impact the entire ipsilateral UE. Impairments can include decreased mobility, strength, and sensation as well as pain. The purposes of this retrospective case report were two-fold. First was to investigate the impact of conservative treatments on pain and functional limitations of a 40-year-old female with an acute shoulder injury. Second was to differentiate whether the patient’s symptoms were primarily due to traumatic nerve injury, musculoskeletal injury, or other factors.

Case description: A 40-year-old female referred to an outpatient (OP) physical therapy (PT) for L shoulder pain and radiating symptoms began after getting involved in a scuffle with a motorist who pulled her L arm vigorously. The initial symptoms indicated more of a nerve traction injury than musculoskeletal damage. The intervention included manual techniques, therapeutic exercises to improve shoulder mobility, pain management and postural exercises. Self-reported outcome measures and functional outcome measures (UEFI, NPRS) were utilized to assess improvements.

Outcomes: The intervention caused no adverse effects to the patient’s condition. Throughout the Plan of Care, significant improvement was noted in shoulder mobility (AROM and PROM); UEFI improved from 15/80 to 35/80; pain intensity on NPRS decreased (worse pain from 7/10 to 5/10; best pain level from 2/10 to 1/10; at rest from 5/10 to 2/10); Manual Muscle Testing showed significant improvements in all L shoulder muscle groups.

Discussion: The musculoskeletal treatment approach was safe and appeared to be beneficial for addressing the L shoulder injury. Overall, symptoms originally suggested a potential BPI. However, based on improvement and recovery time while in physical therapy, the injury appeared to be more musculoskeletal than neurological in nature. Considering the time typically required for recovery of BPI, the POC would have been different if the patient had a confirmed BPI. This case report may be useful for tailoring interventions to patients with similar shoulder injuries. Additionally, future study should consider investigating the addition of a digital app based HEP and impact on patient’s use of HEP as well as efficacy of dry needling to help eliminate pain and tenderness. For clinical judgement, electromyography initially would have helped to determined differential diagnosis considering the mechanism of injury.

Keywords: Shoulder traction injury (musculoskeletal injury or BPI), soft tissue mobilization, ROM exercises, therapeutic exercises."

Presenter:
Saural Bhatt
Physical Therapy Doctoral Student