Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with right shoulder pain, insidious in onset, localized to the lateral deltoid region. Pain is exacerbated by overhead activities, reaching behind the back, and nocturnal recumbency on the affected side. Denies history of acute trauma, radicular symptoms, or mechanical locking. Pain intensity is rated at [X]/10, described as [aching/sharp].
Clinical Examination Findings
Inspection: No visible atrophy of the supraspinatus or infraspinatus fossae. Palpation: Tenderness noted over the greater tuberosity and subacromial space. Range of Motion (ROM): Active ROM limited by pain in abduction and internal rotation. Passive ROM is full but painful at end-range. Special Tests: Neerโs sign (+), Hawkins-Kennedy test (+), Jobeโs test (empty can) (+), and painful arc sign present between 60-120 degrees of abduction. Neurovascular: Distal pulses intact; sensation and motor strength intact in C5-T1 distribution.
Treatment Protocol
1. Activity modification: Avoid overhead lifting and repetitive reaching. 2. Pharmacotherapy: NSAIDs (e.g., Ibuprofen 400mg TID or Naproxen 500mg BID) for 10-14 days. 3. Physical Therapy: Focus on rotator cuff strengthening, scapular stabilization, and posterior capsule stretching. 4. Modalities: Ice application for 15 minutes post-activity. 5. Follow-up: Re-evaluate in 4-6 weeks; consider subacromial corticosteroid injection if refractory to conservative management.