Physiotherapy treatment of patient with diagnosis calcific tendinitis of the rotator cuff

Uvod: Kalcinirajoči tendinitis rame je pogosto stanje neznanega vzroka, za katero je značilno odlaganje kristalov kalcijevega hidroksiapatita v eno ali več tetiv mišic rotatorne manšete. Najpogosteje je prizadeta tetiva mišice supraspinatus. Kalcinirajoči tendinitis večinoma prizadene ženski spol okoli 50. leta starosti. Etiologija kalcinirajočega tendinitisa je večinoma neznananjegov nastanek je lahko posledica več dejavnikov. Namen: Namen diplomskega dela je predstaviti fizioterapevtsko obravnavo pacientke z diagnozo kalcinirajočega tendinitisa mišic rotatorne manšete. Metode dela: Diplomsko delo je poročilo o primeru. Metode dela vključujejo fizioterapevtsko oceno pacientkinega stanja, izpostavitev problemov, ciljev fizioterapevtske obravnave in izbor fizioterapevtskih postopkov zdravljenja. Fizioterapevtska ocena pacientkinega stanja je vključevala anamnezo, inspekcijo, palpacijo, goniometrične meritve gibljivosti in orientacijsko testiranje mišične zmogljivosti ramenskega sklepa, oceno artrokinematike skapulotorakalne povezave ter oceno bolečine in funkcionalnosti zgornjega uda. Meritve so bile opravljene pred fizioterapevtsko obravnavo in po njej. V našem primeru je zdravljenje kalcinirajočega tendinitisa vključevalo kombinacijo fizioterapije in medikamentozne terapije z nesteroidnimi antirevmatiki. Fizioterapevtski postopki, ki smo jih uporabili, so bili metode fizikalne terapije in kinezioterapije ter manualne terapije. Rezultati: Pri prvem ocenjevanju je ocena pacientkinega stanja pokazala značilno omejeno gibljivost in zmanjšano mišično zmogljivost desnega ramenskega sklepa, prisotnost stalne bolečine v desnem ramenskem sklepu in zmanjšano funkcionalnost zgornjega uda. Po fizioterapevtski obravnavi, ki je trajala dva tedna in vključevala osem terapij, so rezultati večinoma ostali enaki. Prišlo je le do izboljšanja obsega gibljivosti desnega ramenska sklepa v smeri antefleksije in zunanje rotacije. Razprava in zaključek: Kalcinirajoči tendinitis rame je stanje, ki povzroči značilne funkcijske omejenosti zgornjega uda. Glavno težavo pri večini pacientov predstavlja bolečina v prizadetem zgornjem udu, ki omejuje uporabo zgornjega uda pri izvajanju vsakodnevnih aktivnosti. Posledično pride do zmanjšanega obsega gibljivosti in mišične zmogljivosti prizadetega ramenskega sklepa. Konservativno zdravljenje kalcinirajočega tendinitisa večinoma vključuje medikamentozno terapijo in uporabo fizioterapevtskih postopkov. Čeprav se je pri večini pacientov takšna kombinacija zdravljenja pokazala kot učinkovita, pri naši pacientki ni prišlo do izboljšanja stanja.Indroduction: Calcific tendinitis is a common disorder of the shoulder, of unknown etiology, characterized by deposition of calcium hydroxyapatite crystals inside one or more tendons of the rotator cuff muscles. The most commonly affected tendon of the rotator cuff muscles is the tendon of supraspinatus muscle. Calcific tendinitis usually affects women, with a prevalence in their fifth decade of life. The etiology of calcific tendinitis is still not completely understood and its origin may be multifactorial. Purpose: The purpose of the diploma work is to present the physiotherapy treatment of the patient with diagnosis calcific tendinitis of the rotator cuff muscles. Methods: The diploma work is case report. The working methods included physiotherapeutic assessment of the patients condition, setting patient\u27s problems, goals of physiotherapeutic treatment and choosing physiotherapeutic methods and techniques for treatment of calcific tendinitis. Physiotherapeutic assessment of the patient\u27s condition included goniometric measures of shoulder mobility, orientation test of shoulder muscle strength, arthrokinematics of the scapulothoracic joint, rating of the pain intensity and functionality of upper extremity. Measures were made before and after the physiotherapy treatment. In our example treatment of calcific tendinitis included a combination of physiotherapy and nonsteroidal anti–inflammatory drugs. Physiotherapy included use of physical and kinesiotherapy methods, and manual therapy. Results: At the first measurement, assessment of the patients condition has shown a significantly limited range of motion and reduced muscle strength of the right shoulder joint, presence of constant pain in the right shoulder joint and reduced functionality of upper extremity. After the physiotherapy treatment, which lasted for two weeks and included eight therapies, results mainly remained the same. Only the range of motion of shoulder anteflexion and external rotation has increased. Discussion and conclusion: The calcific tendinitis of the shoulder is a condition that causes functional limitation of the upper extremity. The main problem with most patients is the pain in the affected upper extremity, which limits the use of upper extremity with everyday activities. The result of that is the reduced range of motion and reduced muscle strength of the affected shoulder joint. The conservative treatment usually includes medicament therapy and the use of physiotherapy. Although that combination of treatment turned out to be successfull in the most of patients, there was no improvement of the condition with our patient