Abstract

Background: The purpose of this case report is to describe a conservative physical therapy plan that was successful in the treatment of a functional classification of subacromial impingement syndrome (SIS). SIS is a common shoulder diagnosis and accounts for approximately 44-65% of shoulder cases presented in primary care [1]. Impingement syndrome can be classified into either a functional or structural categorization, determined by the causative factor, and is frequently seen with repetitive overhead activities [1,2].

Case Description: The patient was a 29-year-old elite female rock climber who presented to our clinic after an extended overseas climbing trip. The patient injured her left shoulder twice during the trip with both injuries occurring while her shoulder was in a flexed and internally rotated position. The patient reported that her painful symptoms resolved after the initial injury with the use of self-treatment with therapeutic exercises found online and performed while on the expedition. Six months later, the patient reinjured her shoulder with the same mechanism of injury. The patient presented to the clinic with signs and symptoms suggesting impingement within the glenohumeral joint.

Discussion/Outcome: After six weeks of manual therapy, therapeutic exercise, and a detailed home exercise program, the patient returned to her normal climbing activities symptom free. Significant gains in range of motion (ROM) of the glenohumeral joint and strength of shoulder musculature and scapular stabilizers were noted through clinical testing and her pain was completely resolved. At discharge, all clinical special tests for impingement were negative and her Quick Disabilities of Arm, Shoulder, and Hand (QDASH) score decreased from 18 to 5.

Conclusion: Through an extensive literature search performed to guide treatments, it was found that a focus on manual therapy techniques was extremely beneficial for a patient diagnosed with SIS. The use of manual therapy as the cornerstone for treatment sessions supplemented with ROM and strengthening activities allowed the patient to return to her previous functional status and rock climbing symptom-free. This case report parallels the current evidence that conservative treatment may be efficacious in the treatment of SIS when the etiology is secondary to a functional classification.

Keywords: Subacromial impingement syndrome, manual therapy, physical therapy