(Shoulder impingement is a common condition that occurs when the tendons or bursae in the shoulder are compressed or pinched between the bones of the shoulder joint. This can result in pain, weakness, and a limited range of motion in the shoulder. In this case study, we will examine a hypothetical patient with shoulder impingement and their diagnosis and treatment)
Patient Information:
Name: Ali
Age: 35
Occupation: Computer programmer
Presenting Complaints:
A 26-year-old young male presented with throbbing pain in his left shoulder for the last past one month. The patient complains of pain when lying on the affected side while performing the overhead movements. The patient also experiences some mild aching pain in his neck region. The patient feels pain when reaching his arm behind his back like reaching into a back pocket.
History of presenting complaints:
He is an employee of an IT company in Pakistan. The patient plays cricket every weekend. Due to this activity shoulder muscles get overused. All this causes shoulder impingement pain in his left shoulder.
Chief complaints:
“Left shoulder pain for the past month”
Past medical and surgical history:
- NILL
Family history:
- None
Socioeconomic status:
- The patient belongs to a middle-class family
Present and pre-morbid functional status:
The patient is unable to perform his activity of daily living (ADLs) due to this pain.
General Health status:
Level of awareness……conscious……………. Body type……Normal. Posture….
Thyroid ……Normal……………… Lymph node……Normal………….
Smoker / Nonsmoker (Packs per day)……Nonsmoker…………
Vitals:
Respiratory rate …18bpm…………….. Blood pressure ……115/82mmgh……
Temperature……98 F…………… Oxygen saturation……98%
Pulse…78……….
Aggravating factors:
- Shoulder elevation, reaching overhead
- Reaching for his wallet in his back pocket.
- Sleeping in any position at night, aggravate symptoms
- Pulling on a shirt.
Easing factors:
- Rest
- Avoid Aggravating movement.
Examination:
- Sleep and 24-hour pattern:
The patient is unable to sleep at night due to the pain. Symptoms only occur during movement of the arm especially overhead and extension.
- Duration of current symptoms:
1 month
- Mechanism of injury/current symptoms:
Unknown
- Progression since the current episode:
Getting worse
- Significant prior history:
Fall from a bike 6 years ago.
- Previous treatment:
No physiotherapy treatment, mediational only likes Ansaid’s
- Diagnostic Test/Imaging:
None at this time
Differential diagnosis:
- Rotator cuff tear
- Mechanical neck pain
- Impingement syndrome
Post-physical examination and conclusion:
- Postural observation:
No abnormalities
- Precaution and contraindications:
None
- Functional movement analysis (Sign):
Pain with overhead reaching, reaching out in front of the body and in extension.
- Quick screening tests/clearing of additional joint structures:
Cervical spine clear
- Range of motion (ROM):
A painful range of motion termed the painful arc “occurs between 60-120 degrees of outward elevation. Below 60 degrees and above 120-degree individuals are generally able to move their shoulders without pain.
Special Test:
- Hawkins-Kennedy test
- Painful arc
- Full can test
Assessment:
Problem list/complaints:
- Pain
- Postural dysfunction
- Impaired strength
- Decreased functional, ADL performance
Treatment:
For patients with stage 1 impingement, conservative treatment is often sufficient. Conservational treatment involves resting and stopping the offending activity.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and ice therapy are beneficial for pain relief.
Prognosis:
The prognosis is good when there is no history of rotator cuff tear and other co-morbidities. Patients with shoulder impingement do fairly well with physical therapy which lead to a good outcome and improved function.
Goals:
- Increase range of motion
- Improve strength
- Improve self-manage pain
- Increase the function of ADLs
Interventions:
- Patient Education
- Passive range of motion (PROM), active range of motion (AROM)/Active assisted range of motion (AAROM)
- Strengthening of the rotator cuff, shoulder, and scapular musculature
- Joint mobilization of all joints of the shoulder griddle
- Home exercise plan
Patient /family education:
- Patient findings, role, and plan of care
- Postural awareness, ergonomics
- Home exercise plan
- Self-management of pain using positioning and modalities.
Discharge plan:
The patient returns to the previous level of function with a good knowledge of injury prevention.