By

Wahyu Sita Wardani, dr

Data Base Identity
Name : Mr. M
Sex : Male
Age : 69 years old
Address : Jojoran, Surabaya
Occupational : Civil Servant Pensioner
Religion : Moslem
Ethnic : Javanese
Marital status : Married

Referred from Cardiology Outpatient Clinic with Frozen

Shoulder + HT + DM
Chief complaint : Nyeri kedua bahu

History of present illness

Pain at both shoulders since 1 year ago and got worse in last
three month
Pain at the shoulders mostly felt when he moved his arm that
make his shoulder rotated, especially when he tried to take off a
shirt or scratched his back.
He felt difficulty to take his shirt off so he always need help from
his family everytime he want to do it.
The pain described as a dull pain, and decreased when he take a
rest.
There were no tingling sensation, numbness, nor morning
stiffness
He is a civil servant pensioner from Plantation and Forestry
Departments , and now his activity is take and pick up his two
grand children to school by car or motorcycle, mostly by
motorcycle.
History of Past Illness
DM (+) , treated by Insulin, routinely control to
Internal Medicine Outpatient Clinic once a month
Hypertension (+), treated by Lisinopril and
Amlodipin, routinely control to Cardiology Outpatient
Clinic once a month
History of Prostatectomy in 2003 due to Prostate
Carcinoma
Previous trauma (-)
Physical Examination

GENERAL STATUS
CM, independent ambulation, normal gait, right handed
Body Weight : 85 Kg. Body Height : 169 cm. BMI :29,8
(Overweight)
BP : 150/80 mmHg, HR : 84 x/minute , RR : 20 x/minute
Head & Neck : no anemia, icterus, cyanosis & dyspneu
Thorax : Cor : S1S2 sound, murmur -, gallops -
Pulmo : vesiculer, wheezing -/-, ronchi -/-
Abdomen : Meteorismus -,
Hepar / Lien : unpalpable
Extremities : warm acral +/+ , edema -/-
Physiatric examination
Musculoskeletal examination
Cervical ROM MMT
Flexion F (0-450) 5
Extension F (0-450) 5
Lateral Flexion F/F (0-450) 5/5
Rotation F/F (0-600) 5/5

Trunk ROM MMT

Flexion F (0-800) 5
Extension F (0-300) 5
Lateral Flexion F/F (0-350) 5/5
Rotation F/F (0-450) 5/5
 Shoulder ROM MMT
Flexion F/F (0 180) 5/5
Extension F/F (0 80) 5/5
Abduction F/F (0 180) 5/5
Adduction F/F (0 45) 5/5
Ext. Rotation F/F (0 45) 5/5- (pain)
Int. Rotation F/F (0 55) 5/5- (pain)

l
Elbow ROM MMT
Extension-Flexion F/F (0-1500) 5/5
Forearm supination F/F (0-800) 5/5
Forearm pronation F/F (0-800) 5/5

Wrist ROM MMT

Flexion F/F (0-800) 5/5
Extension F/F (0-700) 5/5
Radial deviation F/F (0-200) 5/5
Ulnar deviation F/F (0-300) 5/5
Fingers ROM MMT
Flexion
MCP F/F (0-900) 5/5
PIP F/F (0-1000) 5/5
DIP F/F (0-900) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-200) 5/5
Adduction F/F (200-0) 5/5

Thumb ROM MMT

Flexion
MCP F/F (0-900) 5/5
IP F/F (0-800) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-700) 5/5
Adduction F/F (500-0) 5/5
Opposition 5/5
Hip ROM MMT
Flexion F/F (0-1200) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-450) 5/5
Adduction F/F (0-200) 5/5
Ext. Rotation F/F (0-450) 5/5
Int. Rotation F/F (0-450) 5/5

Knee ROM MMT

Extension-Flexion F/F (0-1350) 5/5

Ankle ROM MMT

Plantar Flexion F/F (0-500) 5/5
Dorsi Flexion F/F (0-200) 5/5
Inversion F/F (0-350) 5/5
Eversion F/F (0-150) 5/5
Toes ROM MMT
Flexion
MTP F/F (0-300) 5/5
IP F/F (0-500) 5/5
Extension F/F (0-800) 5/5

Big Toe ROM MMT

Flexion
MTP F/F (0-250) 5/5
IP F/F (0-250) 5/5
Extension F/F (0-800) 5/5
Neurological examination
N. Cranialis I XII : within normal limit
Physiological Reflexes : BPR +2/+2
TPR +2/+2
KPR +2/+2
APR +2/+2
Pathological Reflexes : Babinski -/-, HT -/-
Sensory deficits : No Sensory deficits
Local Status : R. Shoulder D/S
I : Inflamation (-), swelling (-), redness (-), Deformity (-)
P : Tender point -/- at shoulder , upper trapezius spasm +/+

Special Test
Empty can (-/-)
Drop arm (-/-)
Neer Impingement (+/-)
Yergason (-/-)
Hawkins (+/+)
Apley scratch test
abd ext.rot paracervical
add int.rot paralumbal
Painful arc 120
Diagnosis :
Supraspinatus Impingement Syndrome Dextra/Sinistra
+ DM + HT + Post Prostatectomy ec Prostat
Carcinoma (2 years) + Overweight

Functional diagnosis :
Impairment : Shoulder Impingement syndrome
D/S
Disability : Difficulty to take off a t-shirt by
himself
Handicapped :-
Problem list :
Surgical :-
Medical : Supraspinatus Impingement
Syndrome Dextra/Sinistra + DM +
HT + Post Prostatectomy ec Prostat
Carcinoma (2 years) + Overweight
Rehabilitation Medicine:
R1 (Ambulation) :-
R2 (ADL) : difficulty in take off a shirt by
himself
R3 (Communication): -
R4 (Sociological) :-
R5 (Psychological) :-
R6 (Vocational) :-
R7 (Others) : - Pain on both shoulder (VAS 5)
- Upper Trapezius Muscle Spasm,
- DM, HT, Overweight
Planning :
1. Surgical : -
2. Medical : continue the medication from Internal Medicine and Cardiology
Outpatient Clinic
3. Rehabilitation Medicine :
P. Dx : consult to Nutrition Outpatient Clinic
P.Tx :
Modality : - High TENS 100Hz on Shoulder Region D/S duration : 30
minutes
- Icing
Therapeutic Exercise :
Static Cycle with moderate intensity according to Target
Heart Rate 130,9
P.Mx : Clinical sign, VAS, ROM
P.Ed : Health Education & Home Exercise Program
- Icing at shoulder D/S
- Gentle active ROM exercise at shoulder D/S
Towel Exercise
Summary
Reported a 69 y.o male, referred from Cardiology outpatient
clinic with Frozen Shoulder + DM + HT
Chief complaint was pain at both shoulders
Pain at both shoulders, localized, appears when he moved his
shoulder in rotated position especially when he want to take off
his t-shirt.
Physical examination reveals empty can, neer impingement, and
hawkins were (+)
Diagnosis is Supraspinatous Impingement Syndrome D/S + DM
+ HT + Post Prostatectomy ec Ca Prostat (2 years) + Overweight
Therapy consist of modalities (High TENS), icing and ROM exc.
Health education/ home exercise programs are explaining about
her disease, Icing at both shoulder, Active ROM exercise, and
routinely control to DM and cardiology outpatient clinic
THANK YOU
 PEMERIKSAAN LUAS GERAK SENDI
Luas Gerak Sendi (LGS) atau Range of Motion (ROM) :
luasnya pergerakan yang dapat terjadi pada suatu sendi

a. Aktif (AROM), pasien menggerakkan sendinya secara volunter

Memberi Informasi :
- Kemauan pasien untuk bergerak - Koordinasi
- Tingkat kesadaran - Rentang konsentrasi
- Kemampuan mengikuti perintah - Kekuatan otot
- Gerakan yang menimbulkan nyeri - ROM sendi
- Aktivitas fungsional
b. Pasif (PROM), pemeriksa/gaya dari luar yang menggerakkan sendi pasien

Langkah-langkah pemeriksaan ROM :

1. Buka penutup / pakaian pada bagian tubuh yang akan di periksa
2. Penjelasan dan instruksi
3. Observasi AROM sendi pasien yang normal / tidak sakit
4. Posisi pasien.
5. Gerakan subsitusi dan stabilisasi
6. Pengukuran dengan goniometer
 PEMERIKSAAN KEKUATAN OTOT
MANUAL MUSCLE TESTING / MMT (PEMERIKSAAN KEKUATAN
OTOT MANUAL) :
teknik pemeriksaan kekuatan otot / kelompok otot
volunter dalam bentuk skor / grade, untuk menilai
gangguan yang berhubungan dengan kontraktilitas otot,
myoneural junction, dan lower motor neuron (LMN)

Prinsip : make and brake (lakukan dan lawan)

Faktor yang mempengaruhi kontraksi otot :

- Kesadaran menurun - Kurang / tidak kooperatif
- Nyeri - Spastisitas / rigiditas
- Kontraktur - Usia
- Gender
 Penilaian kekuatan otot didasarkan pada :
1. Kemampuan dari otot / kelompok yang berkontraksi untuk menahan
tahanan yang diberikan secara manual dengan nilai :
- Normal / 5 : bila dapat menahan seluruh tahanan dari
kekuatan otot pemeriksa yang normal
- Good / 4 : bila dapat menahan sebagian tahanan dari
kekuatan otot pemeriksa yang normal

2. Kemampuan dari otot / kelompok otot untuk menggerakkan bagian tubuh

sepanjang luas gerak sendi ( LGS ) :
- Fair / 3 : bila dapat melawan gravitasi
- Poor / 2 : bila tidak dapat melawan gravitasi

3. Ada atau tidak adanya kontraksi otot :

- Trace / 1 : ada sedikit kontraksi otot, tanpa ada gerakan
- Zero / 0 : tidak ada kontraksi otot

3
SHOULDER

Donny
ANATOMI

1. Sendi Glenohumeralis
2. Sendi Suprahumeralis
3. Sendi Akromio- klavikularis
4. Sendi Skapulokostalis
5. Sendi Sterno- klavikularis
6. Sendi Kostosternalis
7. Sendi Kostovertebralis
AROM
Posisi pasien berdiri

Pasien diperintahkan untuk memegang kepala

sisi belakang dan berusaha mencapai
ujung skapulanya

Bandingkan ROM dengan sisi yang lain

Posisi pasien berdiri

Pasien diperintahkan untuk memegang bagian

belakang punggung berusaha menyentuh
ujung bawah skapula

Bandingkan dengan ROM sisi yang lain

 Posisi pasien berdiri

Menyuruh pasien mengangkat kedua lengan

ke samping (abduksi) sampai 90 dengan
siku lurus, putar lengan posisi supinasi
kemudian dilanjutkan mengangkat sampai
ke atas (elevasi)

ABDUCTION ADDUCTION FLEXION - EXTENSION ENDOROTATION - EXOROTATION

 PROM

ABDUCTION - ADDUCTION

FLEXION EXTENSION ENDOROTASI EXOROTASI

Cup your hand over his acromian, place Hold his elbow to his waist, take his wrist in
other hand proximal the elbow joint your other hand
 FLEXION - EXTENSION

ABDUCTION ADDUCTION

ENDOROTATION - EXOROTATION
SCAPULAR ELEVATION

SCAPULAR RETRACTION

SCAPULAR PROTRACTION
 YERGASON TEST

DROP ARM TEST

APPREHENSION TEST
Towel Exercise
Wall Climbing Exercise