Shoulder Case Study

I’ve been trying compile more and more videos and pictures of real life scenarios that I run into on a daily basis. Basically, I want you to be ready for clinical based scenarios on the NPTE.

My current understanding is that there are no videos on the NPTE, but there are frequently pictures that describe and demonstrate a series of questions.

In order to help you prepare for this, I shot this brief video of a patient with bilateral shoulder pain and noticed a few things. Check it out:

Follow Up Questions

This video was shot during active range of motion (AROM) testing. Here are a few questions that you need to be able to answer:

• How would you document what you saw, especially on the right shoulder?
• He complains of severe bilateral shoulder pain, especially on the right. He was a mixed martial arts instructor for many years. What would you expect about PROM testing?
• What special tests would you watch for? Would the painful arc sign be positive?
• In isolated winging, what nerve would be at fault (assuming neurological symptoms)?
• Intervention: What would be your initial intervention?
• What would be the home exercise program?

These are just a few of the possible open-ended questions that you could ask concerning this man’s case.

The key for the NPTE is being able to reason through an examination, evaluation, diagnosis, and intervention without having to rely on the multiple choices provided during the exam.
In this case, I didn’t give you a lot of details. I want you to be able to justify your answer based on key signs that you could see during the shoulder examination.

What would you do?

If you don’t know where to begin, dust off Magee and Kisner & Colby and get some answers about subacromial impingement and scapular instability. You should probably also review what you would do if the serratus anterior, rhomboids, and rotator cuff were all weak and dysfunctional.
You should also practice what you would say to this patient. A bad example would be:

“Your shoulder is messed up. Um…we need to fix it.”

A better example would be:

“It appears that your shoulder blade is not as stable as it needs to be. This could be a source of your symptoms that you get when you’re raising your arm overhead. We will start off with some simple shoulder blade strengthening exercises and begin trying to create a stable base for your shoulder joint. This will probably help you have less pain, especially when lifting your arm overhead.”

What would you say?

I have found that so many students know what different diagnoses look like in a textbook, but have never practiced saying it to a patient in layman’s terms. How would you measure up?
The NPTE is a clinical based test. They give you real-life scenarios and expect you to be able to make decisions based on the information given to you in a picture or perhaps a few paragraphs. You need to look for the key points in these questions.
Bottom line—look for what’s wrong and then try to fix it. But make sure you know what’s actually going on so that you could explain it to your patient.

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