PREFERRED PRACTICE PATTERN3
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
A 40-year-old male carpenter presents with right shoulder pain that has been present for the past 2 months. The patient complains of a dull ache at the anterolateral shoulder that is worsened after working. He reports pain is increasing and he now has difficulty with washing his hair or reaching up into overhead cabinets. He also notes weakness with holding objects out away from his body and lifting a gallon of milk out of refrigerator. He has protracted scapular posture. Posterior capsular tightness is evident. The patient has positive Hawkins Kennedy, Neer, and Painful Arc tests, and negative Drop Arm and ER Lag tests.
Side planks for shoulder stability. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
MRI demonstrating (A) normal shoulder anatomy and (B) cystic changes at the greater tuberosity with rotator cuff tear (arrow). (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Shoulder pain and dysfunction due to compression and abrasion of the subacromial bursa beneath the coracoacromial arch.
The coracoacromial arch consists of the undersurface of the acromion, coracoacromial ligament as well as the undersurface of the acromioclavicular (AC) joint.
Subacromial bursa lies beneath the acromion and serves to cushion the rotator cuff tendons from the osseous undersurface of the acromion.
Subacromial bursitis results when the subacromial bursa fills with blood and serous fluid as response to either acute or repeated micro-trauma (compression and/or abrasion).
Subacromial bursitis leads to subacromial impingement syndrome, which is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms that can impact both treatment and prognosis.
Compression or abrasion of the subacromial bursa can be either acute, involving a fall, usually on a flexed elbow, or chronic, which can be more multifactorial in nature
Chronic (repeated micro-trauma) mechanism thought to be related to intrinsic and/or extrinsic mechanisms