Thoracic Pain M.W.

Case Description: Pt is an 86 year old female who arrived to physical therapy with reports of left sided upper back/thoracic pain which came on about a month prior after trying new exercise machines at Evergreen Commons. She had chest x-rays (no significant findings) and was given prednisone but did not take due to her fear of side effects. She describes her pain as a dull pain along her shoulder blade as well as occasional numbness down her left arm. Her biggest complaints are difficulty with sleeping, performing her regular physical activity routine, and performing self care tasks such as doing her hair. Pt has a history of rotator cuff tear on the right side.

Objective Measures: The patient was seen for physical therapy for 7 visits over a course of 5 weeks.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
QuickDASH Scale	31.8% disability	9.1% disability
NPRS	At worst 7/10 At best 0/10	At worst 0/10
Palpation	Painful along scapular borders on left side and throughout left rib cage with manual pressure	Grossly non tender around scapular borders
AROM screening	Neck: flexion: full painful, extension: 50% limited & painful Thoracic: mild pain in right upper back with with left rotation & extension Shoulder: all WFL & nonpainful aside from a pull during left sided internal rotation	Neck: flexion: full nonpainful, extension: 60-65% of WNL nonpainful Thoracic: extension nonpainful and WNL, rotation 85-90% of WNL bilaterally and nonpainful Shoulder: all WFL and nonpainful
Shoulder strength	Flexion: 3+/5 bilaterally Abduction: 3+/5 bilaterally; painful on the R External Rotation: R: 3/5 L: 3+/5	Flexion: R: 4-/5 L: 4+/5 Abduction: R: 3+/5 L: 5-/5 External Rotation: R: 3/5 L: 5/5
Functional Capacity	Patient has difficulty with lifting and reaching which limits her ability to perform self care tasks such as doing her hair and dressing. She also has difficulty sleeping due to pain.	Patient’s sleep is no longer disrupted due to pain. She is able to perform her self care tasks with minimal tingling in her R upper back but this does not limit her day to day function.

Summary: The patient was discharged from physical therapy after reporting 90% improvement since start. She states her pain is gone but she does have occasional tingling in her upper back and arm that does not limit her day to day function. She is able to sleep without pain waking her up and she is able to perform reaching and lifting for self care activities that were previously limited. She was given a home exercise program to continue utilizing for maintenance of range of motion and strength.