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Here is a brief overview of the case I will be presenting:
The patient is a 53 y/o male referred to physical therapy with right and left shoulder pain with listed potential diagnoses: incomplete RTC tear, bicipital tendonitis, articular cartilage disorders, bursitis and possible labral tear. His chief complaints include deep ache/stabbing pain in R lateral shoulder with reaching OH, behind his back and sleeping on his R side, stabbing pain in his L lateral shoulder with throwing and reaching behind his back, and occasional numbness/tingling in R>L anterior forearm and hand while using the mouse at his computer that is worse after increased activity.
Initial hypotheses included: primary subacromial impingement, Partial RTC tear/tendinopathy, biceps tendinopathy, TOS, C5/6 cervical facet arthropathy or Stenosis, and C6-8 Cervical Radiculopathy.
He presents with mod severity and low irritability, nature is more musculoskeletal with somatic/nociceptive pain with some neuropathic pain involved, within the chronic stage and staying relatively stable. Objective measures include: painful arc with shoulder flexion and abduction, impaired shoulder ROM on the R>L, pain with MMT and TTP to the RTC muscles, and (+) special tests for impingement.
Treatment focused on manual therapy initially at the GHJ, but progressed to address surrounding structures, therapeutic exercise to strengthen parascapular muslces and improve ROM, and education on expected plan of care and keeping up with HEP.
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