Right shoulder pain — sharp, anterior. Referred by Dr. Smith for shoulder evaluation.

"I just want to be able to reach overhead for work again without pain."

Onset: Gradual, 2 months post-op. Location: Right knee, anterior. Duration: Intermittent, persistent with activity. Character: Aching and stiffness at rest; sharp with movement. Aggravating: Stair climbing, prolonged sitting, morning stiffness. Relieving: Ice, gentle movement, prescribed exercises. Timing: Worse in AM, improves throughout day.

1. Return to overhead work pain-free within 6 weeks. 2. Return to recreational tennis within 6 months. 3. Walk independently without assistive device.

DVT screen: Negative. No calf swelling, warmth, erythema. Denies chest pain, SOB. No post-surgical complications. Cleared for evaluation.

Patient ambulated into clinic independently. Mild guarding of right upper extremity. Incision well-healed, no signs of infection. Mild anterior shoulder swelling.

Antalgic gait, reduced right stance phase. Decreased terminal knee extension at toe-off. Mild Trendelenburg sign (R). Step length symmetry ~75%.

Subacromial impingement syndrome, right shoulder, with supraspinatus weakness. High-complexity presentation: joint (ROM deficit, effusion), muscle (MMT 3+/5), gait dysfunction. Strong rehab candidate.

Good. Patient highly motivated, active prior level of function. Expected full return to ADLs within 6 weeks, sports by 6 months given compliance.

2× per week × 12 weeks (24 visits). Plan of Care expiration: 90 days. Auth: 12 visits (BlueCross).

STG (3 wk): Flexion 110°, full extension 0°, eliminate quad lag. LTG (12 wk): Flexion 130°, symmetrical extension, functional gait. Interventions: Patellar mob, heel props, low-load prolonged stretch.

Phase 1: Quad sets, SLR 4-way, TKE with band, mini-squats 0–30°. Progress to step-ups, leg press 0–60°, hamstring curls at Week 4.

1. Quad sets — 3×15, 2×/day 2. Heel prop extension — 10 min, 3×/day 3. SLR — 3×15, daily 4. Ankle pumps — 2×10, hourly 5. Ice — 20 min post-exercise Sent to patient portal for review.

Wedding Milestone (3 months): Lateral movement pain-free, SLS 30 sec. Progress note at Visit 10. Re-eval Week 6. Discharge planning begins Week 10.