title: Management of a patient with shoulder pain and disability: a manual physical therapy approach addressing impairments of the cervical spine and upper limb neural tissue.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  Shoulder pain and disability is a common clinical problem that may be influenced by impairments from a variety of sources. The purpose of this case report is to illustrate a manual physical therapy management approach for a patient with shoulder pain and disability, specifically addressing impairments of the cervical spine and upper limb neural tissue believed to contribute to the patient's symptoms.
  
  
  METHODS
  The patient was a 45-year-old female research scientist with symptoms of anterior shoulder and posterior scapular region pain that limited her ability to use her right upper extremity for normal activities of daily living. An examination and evaluation revealed impairments of the cervical spine and upper limb neural tissue that were believed to contribute to the patient's symptoms. Intervention consisted of joint mobilization directed at the impaired cervical spine segment. The Shoulder Pain and Disability Index (SPADI) and goniometric measurement of shoulder range of motion (ROM) were used to measure outcomes following the intervention.
  
  
  RESULTS
  The patient was seen once a week over the course of 5 weeks. The patient's SPADI score improved from 83% to 1.5% over the course of treatment. Active ROM of shoulder flexion improved from 50 degrees to 155 degrees over this period of time. A 6-month follow-up revealed a full return to usual activity and a SPADI score of 0%.
  
  
  CONCLUSIONS
  A manual physical therapy approach addressing impairments of the cervical spine and upper limb neural tissue may lead to improved outcomes in the management of patients with shoulder pain and disability.
authors.affiliation: Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA. erik.haddick@kp.org
authors.forename: Erik
authors.initials: E
authors.lastname: Haddick
mesh_terms: D000203:Activities of Daily Living; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010808:Physical Examination; D026741:Physical Therapy Modalities; D012785:Shoulder Joint / Q000294:innervation; D020069:Shoulder Pain / Q000534:rehabilitation*