Examination and Conservative Management of Shoulder Pain:A Systematic Tissue Specific Approach

The use of examination procedures to identify specific tissue involvement in painful conditions is a critical element in musculoskeletal physical therapy practice. Physical therapists can benefit from this approach to patient examination because it allows them to focus treatments on the specific causes of symptoms. The purpose of this case study is to describe a systematic approach to examination and treatment of shoulder pain through the identification of specific pain generators. The patient presented in this case had a five month onset of left anteriolateral shoulder pain. Based on the examination findings the physical therapy treatment diagnosis was subscapularis tendinopathy with subacromial bursitis. Initial treatment consisted of manual therapy for symptom. The final phase consisted of scapular stabilization activities and eccentric subscapularis exercise. At discharge the patient returned to all activities and stated that she only noticed her shoulder symptoms when she had a particularly busy shift. This case suggests that using a tissue specific examination and treatment approach may be beneficial in achieving a successful outcome in the treatment of patients with shoulder pain