73 year old female with a diagnosis of nonunion fracture ...

Bay Physical Therapy

Case Study 1 11-26-04 - 8:13 PM

Patient is a 73 year old female with a diagnosis of nonunion fracture of the L surgical neck and bayoneting of the humerus into varus. Patient was initiated on therapy in April 2004. Patient has a history of CA of the L breast with lumpectomy and lymph node removal in the LUE. Additional history includes low back pain. Limiting factors towards progress included pain initially at 7/10, mal-positioning of the nonunion fracture, and hx of CA. ROM had plateaued when the ATM2 was initiated.

Goals were to increase strength in the lower trapezius and external rotators of the shoulder; to enable the patient to elevate the arm with a decrease in pain within the limited ROM available; stabilize the spine and trunk without exacerbating back pain. Guidelines were to avoid pain, and reduce risk of stress on the nonunion. The therapist was permitted resistive exercise by the physician.

Active ROM was as follows:
Shoulder Flexion 140 Abduction 110 External Rotation 70 Internal Rotation 70

Patient was set up with 5 straps for manual resistive exercise to external rotators, and 3 straps for active assistive lower trapezius elevation. 

The ATM2 enabled the therapist to concentrate on the L shoulder as the trunk was stabilized and supported. The patient's posture was not an issue while in the ATM2. Stabilization prevented substitution of the upper trapezius or trunk side bending during the activity. Strength increased from 3+/5 to 4-/5, pain decreased from 5/10 to 2/10 by 9/30/04 when the patient left for a 3 week trip to Japan.