Effect of sternoclavicular joint mobilization on pain and function in a patient with massive supraspinatus tear

Abstract

Massive irreparable rotator cuff tears can be difficult to treat conservatively, especially when the patient has multiple comorbidities. Although there is evidence to support interventions aimed at the spine, there is paucity in the literature describing interventions to the sternoclavicular joint (SCJ) in individuals with rotator cuff pathology. A 57-year-old female with multiple comorbidities and a body mass index of 59 was referred to physical therapy with a 4-month history of right shoulder pain, significant functional limitations, and magnetic resonance imaging (MRI), demonstrating a full-thickness supraspinatus tear. She presented initially with active shoulder flexion range of motion (ROM) 0-80°, numeric pain rating scale (NPRS) 7/10, and QuickDASH 65.9%. After six physical therapy sessions, the patient had plateaued with improvements in pain and ROM. SCJ mobilizations at visit 7 immediately improved pain, active ROM, and subjective reports of function. The patient was discharged after 13 visits with increased active shoulder flexion ROM to 0-170°, NPRS 1/10, QuickDASH 31.8%, and Global Rating of Change (GROC) +5. This case highlights the successful conservative treatment of an individual with an irreparable rotator cuff tear and numerous comorbidities by using a multimodal approach including SCJ mobilizations.

Clinical results of conservative management in patients with full-thickness rotator cuff tear: a meta-analysis

“…The intervention period of the conservative treatment in these investigations ranged from 3 weeks to 2 years. The mean final outcome measurements were performed at a minimum of 2 months to a maximum of 7.6 years ( Table 1 ) [ 3 , 6 - 32 ].…”

“…The outcome measures used in studies were ROM (15 trials) [ 6 , 8 , 11 - 14 , 16 , 18 - 20 , 24 - 26 , 31 , 32 ], Constant score (13 trials) [ 3 , 9 - 11 , 14 , 16 , 18 - 22 , 24 , 30 ], pain (10 trials) [ 3 , 6 , 8 - 10 , 12 , 16 , 18 , 19 , 22 ], strength (10 trials) [ 7 , 8 , 13 , 14 , 16 , 19 - 21 , 25 , 32 ], American Shoulder and Elbow Surgeons score (seven trials) [ 7 , 15 , 19 , 20 , 29 - 31 ], SF-36 score (four trials) [ 19 , 20 , 23 , 27 ], Western Ontario Rotator Cuff Index (three trials) [ 7 , 8 , 15 ], Simple Shoulder Test score (three trials) [ 9 , …”

A rare case report on physical therapy rehabilitation of arthroscopic repair of full-thickness supraspinatus tear in a 61-year-old woman

“…Rotator cuff tear prevalence is 39% in asymptomatic individuals and 64% in symptomatic individuals Authors' Affiliation: 1 Junior Resident Department of Neuro physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences Wardha, Maharashtra, India; Email: physioswati24@gmail.com; ORCIDhttps://orcid.org/0000-0003-0200-0939 2 Resident, Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences Wardha, Maharashtra, India; Email: lakhwanimadhu9@gmail.com, ORCID: https://orcid.org/0000-0003-3039-4736 (Sambandam, 2015). Participation in the society and activities at the physical level are hindered at a significant rate in such patients (Mischke et al, 2016). The tendons of the rotator cuff connect with the joint capsule and coracohumeral ligament before inserting into the humeral tuberosity.…”