Optimal management of shoulder impingement syndrome

Escamilla, Rafael F.; Hooks, Todd; Wilk, Kevin E.

doi:10.2147/oajsm.s36646

Cited by 64 publications

(49 citation statements)

References 79 publications

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“…Upon initial examination, the patient presented with a QDASH score of 18. At the time of discharge, the patient had decreased that score to 5, representing a 13-point change, which meets the minimal detectable change of the QDASH [13]. Pain decreased to a subjective pain rating of 0/10 at the end of the treatment sessions.…”

Section: Discussionmentioning

confidence: 92%

Physical therapy management of an elite rock climber with subacromial impingement syndrome (SIS)

Zollinger¹,

Urfer²,

Gerber³

2018

Phys Ther Rehabil

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Background:The purpose of this case report is to describe a conservative physical therapy plan that was successful in the treatment of a functional classification of subacromial impingement syndrome (SIS). SIS is a common shoulder diagnosis and accounts for approximately 44-65% of shoulder cases presented in primary care [1]. Impingement syndrome can be classified into either a functional or structural categorization, determined by the causative factor, and is frequently seen with repetitive overhead activities [1,2]. Case Description: The patient was a 29-year-old elite female rock climber who presented to our clinic after an extended overseas climbing trip. The patient injured her left shoulder twice during the trip with both injuries occurring while her shoulder was in a flexed and internally rotated position. The patient reported that her painful symptoms resolved after the initial injury with the use of self-treatment with therapeutic exercises found online and performed while on the expedition. Six months later, the patient reinjured her shoulder with the same mechanism of injury. The patient presented to the clinic with signs and symptoms suggesting impingement within the glenohumeral joint. Discussion/Outcome: After six weeks of manual therapy, therapeutic exercise, and a detailed home exercise program, the patient returned to her normal climbing activities symptom free. Significant gains in range of motion (ROM) of the glenohumeral joint and strength of shoulder musculature and scapular stabilizers were noted through clinical testing and her pain was completely resolved. At discharge, all clinical special tests for impingement were negative and her Quick Disabilities of Arm, Shoulder, and Hand (QDASH) score decreased from 18 to 5. Conclusion: Through an extensive literature search performed to guide treatments, it was found that a focus on manual therapy techniques was extremely beneficial for a patient diagnosed with SIS. The use of manual therapy as the cornerstone for treatment sessions supplemented with ROM and strengthening activities allowed the patient to return to her previous functional status and rock climbing symptom-free. This case report parallels the current evidence that conservative treatment may be efficacious in the treatment of SIS when the etiology is secondary to a functional classification.

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Section: Discussionmentioning

confidence: 92%

Physical therapy management of an elite rock climber with subacromial impingement syndrome (SIS)

Zollinger¹,

Urfer²,

Gerber³

2018

Phys Ther Rehabil

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“…Manual therapy techniques combined with therapeutic exercise, particularly upper quarter joint articulation [21], appear to provide better outcomes than therapeutic exercise alone [5]. This is especially the case when it is evident that poor scapulothoracic stabilization and weakness in the rotator cuff muscles is prevalent [22]. Abnormal positioning of the scapula as a result of weakness of the scapulothoracic muscles can lead to a reduction in the subacromial space [18,23].…”

Section: Discussionmentioning

confidence: 99%

The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report

Bennett

Macfarlane

Vaughan

2017

EXPLORE

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Rotator cuff dysfunction is common in athletes involved with overhead sports. Secondary subacromial impingement is a common cause of pain for patients with rotator cuff dysfunction. Exercise rehabilitation and manual therapy can be used in the treatment of subacromial impingement to decrease pain, increase functionality and support a return to activity. The current case report describes a 24-year-old patient with supraspinatus tendinosis and secondary subacromial impingement who was experiencing pain when playing tennis, and during daily activities involving overhead movements. Osteopathic manual therapy and rehabilitation was undertaken leading to significant improvements in pain and function over a six-week period. The current case report describes an evidence-informed approach to the management of subacromial impingement syndrome whilst incorporating a manual therapy technique, balanced ligamentous tension, that has received little attention in the literature.

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“…Overhead athletes typically have internal impingement, when the arm abducts and externally rotates which causes impingement between the posterosuperior labrum and the undersurface of the supraspinatus and infraspinatus tendons. The most common site for impingement is the supraspinatus tendon at the critical zone, which is its insertion site [ 26 ].…”

Section: Scapular Dyskinesismentioning

confidence: 99%