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An 18-year-old right-hand dominant male presents to an outpatient physical therapy clinic with a physical therapy prescription from an orthopaedic physician to evaluate and treat right shoulder subacromial impingement. The patient states he started to experience shoulder pain approximately four weeks ago. He attributes the cause to playing tennis three times during the past week after not playing at all over the winter. His right shoulder pain increases with reaching forward, reaching behind his back, lifting any type of weight with his right arm and playing tennis. He also reports not being able to reach behind his back to loop his belt or tuck his shirt in, activities he could previously do without difficulty. The only position that relieves his shoulder pain is keeping his arm at his side. His physician started him on a course of nonsteroidal anti-inflammatory drugs, which has helped decrease the pain intensity. X-rays (performed in the physician's office) of the acromioclavicular and glenohumeral joints were negative for any bony abnormalities or structural deficits. The patient's medical history is otherwise unremarkable.

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Based on the patient's diagnosis, what do you anticipate may be the contributing factors to his condition?

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What examination signs may be associated with this diagnosis?

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What are the most appropriate physical therapy interventions?

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What possible complications may limit the effectiveness of physical therapy?

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SCAPULAR DYSKINESIS: Visible alterations in scapular position and movement patterns

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SUBACROMIAL IMPINGEMENT SYNDROME: Compression, entrapment, or mechanical irritation of the rotator cuff tendons beneath the coracoacromial arch

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  1. Describe subacromial impingement syndrome.

  2. Identify possible causes of subacromial impingement.

  3. Discuss signs and symptoms of subacromial impingement based on examination findings.

  4. Prescribe appropriate joint range of motion and/or muscular flexibility exercises for an individual with subacromial impingement syndrome.

  5. Prescribe appropriate resistance exercises for a person with subacromial impingement syndrome.

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PT considerations during management of the individual with a diagnosis of subacromial impingement syndrome:

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  • General physical therapy plan of care/goals: Decrease pain; increase glenohumeral joint range of motion; increase muscle flexibility; increase rotator cuff and scapular muscle strength; improve function with activities of daily living
  • Physical therapy interventions: Patient education regarding shoulder anatomy and pathomechanics of the diagnosis; modalities as needed to decrease pain; manual therapy to decrease pain and improve joint and muscular flexibility; range of motion and flexibility exercises; resistance exercises to increase muscular strength and endurance; proprioceptive exercises to promote joint and muscular control
  • Precautions during physical therapy: Monitor vital signs; address precautions or contraindications for exercise based on patient's pre-existing condition(s)
  • Complications interfering with physical therapy: Patient noncompliance with exercise program

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Shoulder pain affects 16% to 21% of the adult population in the United States, second only to low back pain in total prevalence of musculoskeletal conditions.1-4 Subacromial impingement syndrome (SAIS) accounts ...

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