Presenting Complaints:
A 32-year-old male presents with complaints of persistent pain and snapping sensations in the left scapular region whenever he raises his arm or performs overhead activities. The patient reports that the pain has been gradually worsening over the past six months, and it has started to interfere with his daily activities and work responsibilities.
History of Presenting Complaints:
The patient describes the pain as a sharp, stabbing sensation accompanied by an audible snapping sound during movement. Initially, he noticed occasional discomfort, but it has progressed to a point where he experiences pain and snapping sensations with almost every arm movement, particularly during activities such as reaching overhead, lifting objects, and pushing activities.
Chief Complaints:
Pain and snapping sensations in the left scapular region.
Difficulty in performing overhead activities and lifting objects.
Past Medical and Surgical History:
The patient has a history of mild asthma that is well-controlled with an inhaler as needed. He has never undergone any surgical procedures.
Family History:
There is no significant family history of musculoskeletal disorders or other relevant conditions.
Socioeconomic Status:
The patient is employed in a sedentary office job and has a middle-class socioeconomic status. He has medical insurance coverage.
Present and Pre-morbid Functional Status:
Prior to the onset of his current symptoms, the patient had no notable musculoskeletal issues. He was physically active and regularly engaged in recreational sports.
General Health Status:
Apart from the scapular issue, the patient’s general health is stable. He reports no fever, weight loss, or other systemic symptoms.
Vitals:
Vital signs including heart rate, blood pressure, respiratory rate, and temperature are within normal limits.
Aggravating Factors:
The pain and snapping sensations are aggravated by overhead activities, lifting objects, and movements that require the use of the left arm.
Easing Factors:
Rest and avoiding aggravating movements provide some relief from the symptoms. Applying ice and taking over-the-counter pain medications also temporarily alleviate the discomfort.
Examination:
On physical examination, a noticeable snapping sensation is felt and heard during passive and active shoulder movements. Palpation of the left scapular region elicits tenderness. The patient’s posture and shoulder alignment appear normal. There is no significant muscle atrophy or weakness.
Sleep and 24-hour Pattern:
The patient reports mild difficulty sleeping due to discomfort when lying on his left side. He wakes up occasionally during the night due to the pain.
Duration of Current Symptoms:
The patient has been experiencing symptoms for the past six months.
Mechanism of Injury/Current Symptoms:
There is no history of direct injury to the scapula. The patient attributes the onset of symptoms to a gradual increase in his physical activity levels, particularly involving the left shoulder.
Progression Since the Current Episode:
The symptoms have gradually worsened since their onset. Initially, the snapping sensation was infrequent and less painful, but it has become more frequent and painful over time.
Significant Prior History:
There is no significant prior history of musculoskeletal disorders or related issues.
Previous Treatment:
The patient tried rest, icing, and over-the-counter pain medications, which provided temporary relief but did not resolve the issue.
Diagnostic Test/Imaging:
X-rays and MRI of the left shoulder and scapular region were performed, revealing no fractures or major abnormalities. However, the imaging did show some scapular dyskinesis.
Differential Diagnosis:
Snapping scapula syndrome
Rotator cuff injury
Shoulder impingement
Thoracic outlet syndrome
Postural Observation:
The patient’s standing posture appears to be within normal limits. No evident scapular winging or abnormal positioning is observed.
Precaution and Contraindications:
Avoid activities that exacerbate pain and snapping sensations. Limit overhead movements and heavy lifting until the issue is resolved.
Functional Movement Analysis (Sign):
The snapping sensation and pain occur during movements involving scapular protraction and elevation, such as reaching overhead.
Quick Screening Tests/Clearing of Additional Joint Structures:
Screening tests for cervical spine and shoulder joint mobility indicate no significant limitations or abnormalities.
Range of Motion (ROM):
Active and passive ROM of the left shoulder is within normal limits, although the patient experiences discomfort during certain ranges.
Special Tests:
A scapular dyskinesis assessment reveals abnormal scapular movement and muscle activation patterns during shoulder movements.
Assessment:
The patient presents with snapping scapula syndrome, characterized by scapular dyskinesis and associated pain and snapping sensations during specific shoulder movements.
Problem List/Complaints:
Snapping scapula syndrome with pain and discomfort
Limitation in performing overhead activities and lifting objects
Treatment:
Physiotherapy: A structured physical therapy program is initiated to address scapular dyskinesis and improve muscle imbalances.
Pain Management: Non-prescription pain medications and ice application for pain relief.
Activity Modification: Temporary restriction of overhead and strenuous activities to prevent exacerbation of symptoms.
Prognosis:
With appropriate physiotherapy and activity modification, the prognosis for this patient is positive. Symptoms are likely to improve over time.
Goals:
Reduce pain and discomfort in the scapular region.
Improve scapular stability and function during shoulder movements.
Restore the patient’s ability to perform overhead activities without pain or snapping sensations.
Interventions:
Physiotherapy sessions focusing on scapular strengthening, muscle balancing, and corrective exercises.
Education on proper posture and body mechanics during daily activities.
Gradual reintroduction of overhead activities under the guidance of a physiotherapist.
Patient Education:
Explanation of the condition and its causes.
Proper performance of prescribed exercises and stretches.
Importance of adherence to activity modification recommendations.
Patient/Family Education:
Encourage family support in following exercise routines and activity modifications.
Discuss signs of improvement to watch for and when to seek medical attention.
Discharge Plan:
Continue with the prescribed physiotherapy exercises at home.
Gradually resume normal activities based on physiotherapist guidance.
Follow up with the treating physician and physiotherapist for progress assessment.