18 Year Old Male With Right Shoulder Pain

An 18-year-old right-hand dominant male presents to an outpatient physical therapy clinic with a physical therapy prescription from an orthopaedic physician to evaluate and treat right shoulder subacromial impingement. The patient states he started to experience shoulder pain approximately four weeks ago. He attributes the cause to playing tennis three times during the past week after not playing at all over the winter. His right shoulder pain increases with reaching forward, reaching behind his back, lifting any type of weight with his right arm and playing tennis. He also reports not being able to reach behind his back to loop his belt or tuck his shirt in, activities he could previously do without difficulty. The only position that relieves his shoulder pain is keeping his arm at his side. His physician started him on a course of nonsteroidal anti-inflammatory drugs, which has helped decrease the pain intensity. X-rays (performed in the physician’s office) of the acromioclavicular and glenohumeral joints were negative for any bony abnormalities or structural deficits. The patient’s medical history is otherwise unremarkable.

KEY DEFINITIONS

SCAPULAR DYSKINESIS: Visible alterations in scapular position and movement patterns
SUBACROMIAL IMPINGEMENT SYNDROME: Compression, entrapment, or mechanical irritation of the rotator cuff tendons beneath the coracoacromial arch


Physical Therapy Considerations

Decrease pain; increase glenohumeral joint range of motion; increase muscle flexibility; increase rotator cuff and scapular muscle strength; improve function with activities of daily living

Welcome to your Case Study

Based on the patient's diagnosis, what do you anticipate may be the contributing factors to his condition?
 

What examination signs may be associated with this diagnosis?
 

What are the most appropriate physical therapy interventions?

 

(Adapted from Magee Orthopedics and various upper extremity resources from Thomas Jefferson University. )

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