Male patient aged 44 referred by the GP with impingement diagnosis of the left shoulder. He had already tried physiotherapy and rehabilitation, this without positive results. He is now up for surgery (MRI showed bursitis and changes of the supraspinatus tendon). The patient works as a carpenter, which has been difficult the last year. He feels that he does not have any force left, its painful almost at all times and he can only abduct the shoulder 20 to 30 degrees and has extreme limited external rotation. He experiences sharp local pain by the acromion and some more diffuse pain on the posterior and lateral side of the upper humerus. Difficult to sleep due to pain. Classic impingement syndrome.
Active movements (abduction and external rotation of shoulder) provoked the symptoms immediately. Passive movements were much less provocative but still very limited in ROM.
Palpation indicated changes in the supraspinatus tendon/muscle junction and pain by the insertion of the structure on the greater tubercle of the humerus. Most of the shoulder muscles were restricted and sensitive to touch.
ART treatment on subscapularis, serratus anterior, teres major, triceps (and antagonists) and some of the shoulder ligaments gave almost full range of motion of the shoulder after the first visit. We repeated the session for 4 times during 3 weeks while the patient also did corrective exercises. At the follow up by the GP 6 weeks after, the patient had full range of motion and no pain during normal activity.
This is a typical impingement case where we see the shoulder is moving into a certain protective state (internal rotation + abduction). When the humerus is pulled into an internal rotation position, the space between the humeral head and the acromion (also coracoacromial ligament) decreases. This leads to secondary pressure and friction of the supraspinatus/bursa when moving the shoulder into flexion and abduction. The cycle is repeated until the tissues causing the alternated movement pattern have been released.
Patient saved from the knife