PREFERRED PRACTICE PATTERN3
Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
A 43-year-old male presents to the OP PT clinic with complaints of right shoulder pain. The patient states it has been bothering him for about 4 weeks. He describes the pain as more of a discomfort. He denies any cervical pain and any radicular symptoms in the arms. He thinks it began when he was throwing a Nerf football with his 10-year-old son. The football does not weigh very much and he says he has to throw the ball hard when passing. If he does not use the arm overhead the shoulder does not bother him much. The patient has good strength throughout the shoulder and is negative for an empty can test and acromioclavicular (AC) compression test.
Shoulder pain and dysfunction due to compression and abrasion of one or more of the rotator cuff tendons, the long head of the bicep tendon, and/or the subacromial bursa beneath the coracoacromial arch due to an abnormal mechanical relationship.
The coracoacromial arch consists of the undersurface of the acromion, coracoacromial ligament as well as the undersurface of the AC joint.
Impingement is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms, which can impact both treatment and prognosis.
Evaluating for impingement of the supraspinatus tendon with the “empty can” test. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
A and B. Palpation and location of the subdeltoid portion of the bursa. (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)