Abstract
BackgroundThis paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach.Clinical FeaturesFour patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities.ConclusionThis case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.
Highlights
This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach.Clinical Features: Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching
This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome
Practitioners of manual therapy commonly encounter patients presenting with shoulder pain and symptoms associated with rotator cuff pathology
Summary
Practitioners of manual therapy commonly encounter patients presenting with shoulder pain and symptoms associated with rotator cuff pathology. A likely primary working diagnosis of a Grade ll Primary Rotator Cuff Impingement (Neer classification-Table 5[11]) with Supraspinatus tendonosis was determined, with secondary involvement of the cervical and thoracic spines. The fourth patient presenting was a 40-year-old Caucasian female She presented with right-sided anterior shoulder pain, which was nagging, aching and accompanied by a catching sensation on specific movements. A likely working diagnosis of a Grade ll, Primary Shoulder Rotator Cuff Impingement (Neer classification- refer to Table 5[11]) was determined. All patients were given a basic exercise program with initial emphasis on isometric strengthening of the supraspinatus and infraspinatus muscles This was implemented once a reduction in pain and improved range of motion was noted at a frequency of 4 sets of 10 repetitions, 2–3 times per day. Patient 4 was seen at 4 and 8 weeks with no symptoms of impingement reported and no objective findings
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