Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report.
METHODS
Case report.


BACKGROUND
Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement. CASE DESCRIPTION A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain.


RESULTS
Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four "booster" treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year.


CONCLUSIONS
In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual physical therapy and exercise.


METHODS
Therapy, level 4.
Army-Baylor Sports Physical Therapy Doctoral Program, West Point, NY.
Michael S
MS
Crowell
Bradley S
BS
Tragord
D000328:Adult; D005081:Exercise Therapy; D006801:Humans; D008297:Male; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D026201:Musculoskeletal Manipulations; D010003:Osteoarthritis / Q000503:physiopathology / Q000628:therapy*; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*
arthritis; functional limitation; glenoid erosion; labral tear; scapular weakness; stiffness