Shoulder Impingement Syndrome Case Studies

Physiotherapy Management of Shoulder Impingement Syndrome: A Case Study

Abstract

As first contact practitioners, Physiotherapists are well trained to assess and treat Shoulder Impingement Syndrome (SIS). SIS is a recurrent condition closely related to rotator cuff disease. This article describes the management of a patient with painful movement restriction of right shoulder joint due to Impingement Syndrome with RC disease. The patient made a significant improvement from physiotherapy treatment. The rationale of the management of patients with SIS with associate RC disease is discussed in this article.

Key words: Physiotherapy, Glenohumeral Joint, Rotator Cuff Disease, Shoulder Impingement Syndrome, Supraspinatus Tendinopathy, Biceps Tendinopathy

Secondary external impingement: Secondary external impingement is the inability to keep the humeral head centered in the glenoid cavity during movement because of shoulder instability created by rotator cuff weakness or a loose shoulder joint capsule or ligament. Secondary external impingement is also called Subacromial Impingement Syndrome and is a mechanical compression of the rotator cuff, biceps tendon, or subacromial bursa by the acromion.

During movement, the humeral head narrows the subacromial space, leading to increased compression of the structures within the subacromial space. Functional narrowing of the subacromial space can occur as a result of weak rotator cuff and scapular stabilizing muscles, altered scapular kinematics caused by weak scapular stabilizing musculature, abnormal posture, and posterior shoulder tightness.

b) Internal impingement

Internal impingement or posterior-superior glenoid impingement, occurs as a result of contact between the articular side of the supraspinatus or infraspinatus tendon and the posterosuperior glenoid rim, which leads to undersurface rotator cuff wear and fraying of the glenoid labrum.

The purpose of this paper is to illustrate how a patient with secondary external impingement presenting with unilateral shoulder pain, movement restrictions and poor posture responded to conservative physiotherapy management.

Case presentation

The patient was seen twice a week over the 4 –week course of treatment, afterwards he was seen once a week for another 4 week course of treatment. Ultrasound treatment was applied for the right supraspinatus and long head of biceps tendons with a treatment dose of 3MHz; 0.8 W/cm2; Pulsed 1:1; 6 minutes (Sub-acute stage) to elevate tissue temperatures, increasing blood flow, and facilitating the process of healing.

Manual Therapy Techniques: Myofascial trigger point therapy was applied by digital ischaemaic pressure over upper trapezius and right supraspinatus trigger points for at least 30 seconds to up to 1 minute at a time. Pressure was applied several times in the course of treatment. Different mobilization techniques (Maitland grade 2 and 3 were applied to address pain and stiffness) were initiated with good outcome.

1. Glenohumeral joint traction was performed to decrease the level of pain

2. End-range posterior glide (A-P mobilization) in preposition of flexion to improve shoulder flexion and posterior glide with physiologic motion into external rotation to improve external