Outpatient rehabilitation for a patient with subacromial impingement syndrome

A patient with subacromial impingement syndrome was seen for physical therapy treatment for 12 sessions over the course of 6 weeks in an outpatient pro bono physical therapy clinic. Treatment was provided by a physical therapist student under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with: a Manual Muscle Test (MMT), shoulder Range of Motion (ROM), palpation of the neck and shoulder musculature for trigger point irritation, observation of posture and muscle length, accessory mobilization exam of the shoulder, Hawkins Kennedy test, Drop sign test, Numeric Pain Rating Scale (NPRS), and the Shoulder Pain and Disability Index (SPADI). A plan of care was established to address impairments of decreased strength in the scapular stabilizer muscles, range of motion deficits in the shoulder, hypomobility in the capsule of the shoulder, tightness in the pectoralis major/minor and upper trapezius, poor sitting and standing posture. The plan of care also addressed activity limitations of decreased shoulder functional mobility, and the inability to drive for prolonged periods. It also addressed participation restrictions of playing baseball with his son and performing full job duties. Main goals for the patient were to decrease pain, improve strength of the scapular stabilizers, improve shoulder ROM, improved sitting posture, increase shoulder functional mobility, drive for prolonged periods, sleep, play baseball with his son without pain, and return to full time work duties. Main interventions used were therapeutic exercise, manual therapy, patient education and a home exercise program. The patient met his goals of decreasing pain, improving ROM, maintaining correct sitting posture, improving shoulder functional mobility, driving for prolonged periods, sleeping throughout the night, playing baseball with his son without pain, and returning to full time work duties. The patient was discharged to continue living at home with an independent home exercise program.