1) Medical history – Client is generally healthy and do not have any major medical condition or any allergy. However, it was noted that he declared and complained of discomfort, specifically, experiencing sharp pain on the right side of his shoulder during one of his school match about 1.5 year ago. He described the experience to be one of akin to a “tearing sensation”. It was further noted that he sustained numbness on the right shoulder and ankle joint swell the following day
Consultation was sought then where he was diagnosed with rotator cuff strain, a condition that is very commonly experienced by badminton players.
Specific to the condition, the strain was further defined to be a case of supraspinatus tendon attached to the proximal humerus bone, being strained/ torn from over-exertion during the match.
Client then complained of on-off pain and self-declared less than optimal performance due to excruciating pain on the right shoulder. He is then on off-the-counter painkillers and apply medicated patches to relieve the pain as where needed. Client’s medical history questionnaire did not sight any surgery being performed or recommended.
2) Treatment – Doctor had prescribed pain relief and anti-inflammatory medication for his rotator cuff injury. As with a proposed X-ray, CT Scan/MRI to further confirm the diagnosis, and rule out fracture. Noted that the doctor has also recommended steroid injection directly into the affected area to help reduce any inflammation and to allow Client to proceed with rehabilitation. He went on to the session as recommended by his doctor. The recommended period of a once-fortnightly rehabilitation session is for 6-months.
3) Symptoms – The following where noted from the latest review/feedback from Client:
a) Pain at rest and at night, particularly if lying on the affected shoulder.
b) Pain when lifting and lowering your arm or with specific movements.
c) Weakness when lifting or rotating your arm.
d) Crepitus or crackling sensation when moving your shoulder in certain positions.
4) Psychosocial – Doctor provided counselling for the client to explain that Rotator cuff tear is a common condition that causes pain and functional disability such as limited motion and weakness of the shoulder. Rotator cuff repair generally leads to a considerable decrease in pain and an increase in functional ability of the shoulder. It was also communicated that the determinants of outcomes measured in patients with rotator cuff repair typically have been limited to aspects of physical health, especially surgeon-rated perceptions and measurements. Client were informed the rehabilitation proceeding and duration will likely take 4 to 6 months before he can take on the game again, especially at competition level. A check-in with the client was also done at the rehabilitation stage to discuss his goal and to understand that during the period, he is to take any strenuous exercise slow, including his routine training to optimise outcomes to the proposed interventions. However, it was noted that client complained of 6 months being too long a period and has shared fears of his losing his stamina/level from not maintaining activity level. He has also expressed fear of going for a surgery should his current condition worsens. He has envisaged that the prescribed anti-inflammatory medication, and at maximum of 3months rehab sessions, he will be able to get back to his pre-injury performance.
5) Activity Level – Client has been very active in badminton in his tertiary school days. Apart from his usual training in school, he was actively involved in community tournaments representing his club in winning several tournaments. There is no significant change to this level of activity. He often self-imposes additional training sessions in the evening after school curriculum activity to maintain activity. It was understood that his activity level was at a peak then (approximately 2 years ago) whereby with no proper recovery and monitoring/education given to the young athlete, resulting in him not having a full recovery. The then recommend of 6-months rehabilitation has since lapsed and he is continuing to take off-the counter pain killers. He had mention that he is having some difficulties in his strokes during training, his rotator cuff doesn’t seem to “react as normal”. He has since reduces the week-night training. As compared to his pre-injury training schedule, his current activity/training intensity is about 70%. It is also coupled with his lifestyle change of serving National Service currently.
6) Client Goal – He is currently serving his national service with another 8 more months to his ORD and following up with all his medical treatment (physiotherapy sessions) despite his commitment in national service. Client expressed the following goals: (1) His goals are to regain his physical condition and reinstate his training routine as he wants to continue playing and represent Singapore to play at the national level. (2) Exhaust all non-invasive procedures (ie. Oral or injection medication) prior to any recommendation for a surgery especially since his oral intake of pain-killer seems to be a weekly affair, especially after each training sessions that he have.
7) Support Network and Social Barriers – His superior at work had been very supportive and understanding. He was also being informed that the SAF also supports servicemen with sports background to play for SAF. It was also on learning of his passion and past participations where he was introduced to SAFSA badminton where servicemen will represent their unit formation to play in the inter-formation badminton tournament. There were no sighted social barriers where client thrives in good supportive environment in his professional work-setting.
8) Physical assessment proposal – Client currently is having a well balance routine in both at work and training as well as his follow up medical treatments. A series of screening had been done via questionnaire filled by client himself.
The following are the summarise report extracted from the questionnaire:
Client’s brother is diagnosed with asthma during his childhood and no relapse after his secondary school days, situation is not affecting him nor his parents. He is a smoker, which he picks up after he enlisted into national service, he smokes 3 to 4 sticks a day, however he claims that after he realise he is diagnosed with his mobility difficulties he increases his cigarette intake more. He is advised to quit in to keep a healthy life style and that smoking will affect his performance when training. At time he will drink alcoholic beverage during weekend with friends. Apart from his social life style, he does other recreational sports activity such as jogging, cycling and racquet games. He would spend more time on racquet sports and he played badminton offend. As he is currently undergoing medical treatment, his agility in movement was restricted which he is very worried at this rate of rehab it will cause him not able to peak in time for future tournaments. He was advised to stay focus on his rehab process and physiotherapy for positive outcome, as this is the stage for him to strengthen his injured area for better chance of recovery.