Case Study: Addressing Shoulder Pinching Pain
Overview
This case study examines a common issue—sub-acromial bursitis—and outlines the approach taken to identify and address its underlying causes.
Sub-acromial bursitis often arises from dysfunction in the rotator cuff, bursa, or joint. Understanding the "why" behind the pain is essential for creating an effective treatment plan.
Patient Presentation
Chief Complaint: A 35-year-old patient reports a persistent pinching sensation in the left shoulder, exacerbated by overhead movements, physical activity and after long periods of sitting.
History: The patient describes a gradual onset of pain over three months, with no known trauma. Occupation involves repetitive micro-movements sitting at a desk all day.
Assessment
Initial Consultation:
Getting to know them helped us realise that although the pain is not unbearable, but it’s more than it impacts his ability to focus on work and how hard he can exercise.
We also realised that the pain was affecting sleep and overall tiredness as sleeping on that shoulder was painful
Physical Examination:
Assessment of range of motion (ROM) and functional movements.
Palpation and special tests to evaluate the integrity of the rotator cuff, bursa, and joint mechanics.
Identification of muscular imbalances or joint restrictions.
We also uncovered that there had been an increase in alcohol consumption recently. This can lead to heightened inflammatory responses.
Diagnostic Insights:
Pinching pain linked to poor scapular mechanics and muscle imbalance.
Overuse of compensatory muscles leading to irritation of the rotator cuff and subacromial bursa.
We decided to get an ulrasound study to identify the extent of irritation.
Treatment Approach
Phase 1: Pain Management
Hands-on treatment, including soft tissue release and mobilization, to reduce inflammation and restore ROM.
Education on how to manage exercise load and to change his sitting position on a regular basis to mitigate the repetitous nature of being fixated in one position.
Sub-acromial bursitis responds really well to anti-inflammatory medication - always consult your medical physician before taking any - but a focused course of them really helps initially.
Phase 2: Addressing Root Causes
Targeted strengthening exercises for the rotator cuff and scapular stabilizers.
Stretching and postural corrections to address muscular imbalances and improve biomechanics.
Gradual reintroduction of overhead activities.
Phase 3: Prevention and Maintenance
Incorporation of a tailored exercise program to maintain shoulder health.
Patient was discharged from care the problem was resolved and the impact of the problem was nullified and goals were achieved.
Outcome
We concluded care because:
They were able to focus at work
There were no sleep disturbances
They were able to train freely and confidently
Sub-acromial bursitis can occasionally return, so we talked about early intervention if it does creep back, but withstanding a recurrence, we wished them well without a need for ongoing care.