Subacromial impingement

An irritation of the tendons which compose the rotator cuff muscle as they pass through
the Subacromial space
Name: Omar
Age:52
medical diagnosis:
Subacromial impingement (both)
Physical therapy diagnosis:
Bilateral shoulder pain

Medical and social outline

A 52-year male married patient came to the with complain severe bilateral shoulder pain on NPRS
right shoulder 9/10 and left shoulder 6/10.
his pain started 1 month ago pain was irritable (5 minute) and sharp shooting pain in nature. His
pain aggravates by overhead activity and moving arm in abduction. he has intermittent pain mostly
severe at night or morning. he got relieves by rest and use of ice pack. he takes pain killer when
he has severe pain (caflam and neurogenic). He has stable family back ground.
On observation, shoulder was round, scapula protracted and thoracic kyphosis increased.
On examination right knee movements are limited
Following are the result

Table 1
Movement Active (right) Left Passive Left
(right)
flexion 90 1oo 95 110
extension 45 50 47 55
abduction 70 75 80 90
adduction 10 12 11 15
Ex.rotation 55 60 60 65
Int.rotation 45 46 46 48’

Accessory movements:
AP and PA grade 2,3 are hypo mobile
AC joint caudal glide hypo mobile and painful

On palpation, tenderness present on right shoulder

 Special test
 Hawkins Kennedy right and left shoulder positive
 Near test right and left shoulder positive
 Empty can test right shoulder (+) and left shoulder (-)
 Belly press negative for both shoulder
 Scarf test right (+) left (-)

Problem list

Impairment Functional limitation

Can’t wear cloth
Limited range of motion
Cannot comb hear
pain

Treatment goals:
Short term:
 To manage pain from 9/10 right and left 6/10to 4/10 right and left 2/10 within week
 To improve limited range of motion

Long term:
 Postural correction
 To achieve full ranges of shoulders
 Return to the activity of daily living

Treatment plan:
 Ice pack (5 minutes)
 Tens (15 minutes)
 Ultra sound
 AC joint mobilization
 Inferior caudal glide
 AP and PA glide ac joint (3,4 grade) 3 sets
 Lateral glide with 90-degree abduction
 Lateral glide with 90-degree flexion

Session 1
Patient came to the OPD with the complain of severe bilateral shoulder pain treatments given to
the patient ice pack, tens15minutes.

Session:2
Subjective: Pain reduced little bit on NPRS scale 8/10 right 6/10 left

Objective: Tenderness still present

Patient ranges much improving

movement Active right left Passive Passive left

right
flexion 93 110 97 12o
extension 50 52 53 55
abduction 73 77 85 92
adduction 11 13 13 17
Int.rotation 45 48 50 50
Ext.rotation 57 62 60 67

Treatment
 Ice pack (5 minutes)
 Tens (15 minutes)
 AP and PA glide AC joint (3x30 30 grade 1,2 Maitland approach)
 Inferior caudal glide AC (3x30grade 1,2 Maitland approach)

Home exercise program

 empty can exercise, abduction 9o degree

 Ask the patient to avoid overhead activity

Analysis: patient responding to the treatment

Plan: Same treatment will be given to the patient

Session 3
Subjective : Patient pain reduces on NPRS 6/10 Right and 3/10 left.
Objective: Patient right shoulder tenderness reduces Patient ranges are improving

movement Active Active left Passive Passive left

right right
flexion 95 112 1oo 1119
extension 53 55 55 57
abduction 75 80 8o 85
adduction 13 15 15 20
Int rotation 60 65 65 70
Ext rotation 53 5o 55 55

Treatment
 Ice pack (5 minutes)
 Tens (15 minutes)
 AC joint mobilization joint (3,4 grade 3 x30 30 second hold Maitland approach)
 Inferior caudal glide joint (3,4 grade 3 x30 30 second hold Maitland appro ach)
 AP and PA glide ac joint (3,4 grade 3 x30 Maitland approach)
 Lateral glide with 90-degree abduction AC (3,4grade Maitland approach)
 Lateral glide with 90-degree flexion AC(3,4grade Maitland approach)

Home exercise program

empty can exercise, abduction 9o degree, wall climbing exercise
Analysis: patient responding well to the treatment
Plan: Continue the current exercise plan in further sessions

Out come
Patient pain and tenderness reduce
Physiological ranges also achieved

Reflection
pendulum exercise, can be given to frozen shoulder patient to improve flexibility, increase range
of motion, and reduce pain.