Gamiel Abdallah, Elkhawaga Hosny, Badr Mohamed, Abdullatif Yousef M, Amr Mohamed
Department of Physical Therapy for Musculoskeletal Disorders and Its Surgeries, Faculty of Physical Therapy, Modern University for Technology and Information (MTI), Cairo, EGY.
Faculty of Physical Therapy, Cairo University, Giza, EGY.
Cureus. 2024 Nov 10;16(11):e73398. doi: 10.7759/cureus.73398. eCollection 2024 Nov.
Subcoracoid impingement occurs due to mechanical encroachment of the subscapularis tendon in the subcoracoid space between the coracoid process and lesser tuberosity of the humerus. Although physical therapy is known to have a crucial role in managing this condition, to the best of our knowledge, there is no established physical therapy program in the literature. This case report aims to provide a detailed presentation and diagnosis of a subcoracoid impingement case and to investigate the effects of physical therapy on pain, disability, performance, muscle strength, and ultrasound measurements over a one-year follow-up period. The patient was a 24-year-old male working as a jeweler who had been suffering from dull anterior left shoulder pain for five years. The modified Hawkins-Kennedy test was positive. Additionally, palpation was pain-free, except for severe pain in the coracoid area. The patient was injected with xylocaine into the subcoracoid space and demonstrated a spontaneous relief of pain. Ultrasound imaging showed a narrower coracohumeral distance from full internal rotation on the affected side (0.85 cm) compared to the non-affected side (1.22 cm). Six weeks of multimodal physical therapy program was delivered to the patient. It consisted of electrophysical agents, manual therapy, and therapeutic exercise. Electrophysical agents included conventional transcutaneous electrical nerve stimulation, ice, and phonophoresis. Manual therapy included shoulder mobilization, myofascial release, thoracic mobilization, and posterior capsule stretches. Additionally, scapular muscle-strengthening and Rotator cuff strengthening exercises were delivered to the patient. The patient received 18 sessions for 6 weeks, at a rate of three times per week. Shoulder pain, function, and performance were measured by a numeric rating pain scale, shoulder pain and disability index, and timed push-up test, respectively. The shoulder muscle's peak isometric strength was measured by a hand-held dynamometer. Acromiohumeral distance, coracohumeral distance, supraspinatus thickness, and subscapularis thickness were measured by ultrasound imaging. Six weeks of multimodal physical therapy is a successful intervention for patients with subcoracoid impingement. It resulted in improvements in pain, function, performance, and muscle strength. An increase in coracohumeral distance from full internal rotation was observed at the end of the intervention, as well as after three months and one year.
喙突下撞击综合征是由于肩胛下肌腱在喙突与肱骨小结节之间的喙突下间隙受到机械性挤压所致。尽管物理治疗在这种疾病的管理中起着关键作用，但据我们所知，文献中尚无既定的物理治疗方案。本病例报告旨在详细介绍和诊断一例喙突下撞击综合征病例，并在一年的随访期内研究物理治疗对疼痛、功能障碍、运动表现、肌肉力量和超声测量结果的影响。患者为一名24岁的男性珠宝商，左前肩部钝痛5年。改良的霍金斯-肯尼迪试验呈阳性。此外，除喙突区域有严重疼痛外，触诊时无疼痛。向患者的喙突下间隙注射利多卡因后，疼痛自发缓解。超声成像显示，患侧在完全内旋时的喙肱距离（0.85厘米）比未患侧（1.22厘米）更窄。对患者进行了为期六周的多模式物理治疗方案。该方案包括电物理治疗、手法治疗和治疗性运动。电物理治疗包括传统经皮电刺激神经疗法、冰敷和声透疗法。手法治疗包括肩部松动术、肌筋膜松解术、胸椎松动术和后关节囊拉伸。此外，还对患者进行了肩胛肌强化和肩袖强化训练。患者在6周内接受了18次治疗，每周3次。分别采用数字疼痛评分量表、肩痛和功能障碍指数以及定时俯卧撑试验来测量肩部疼痛、功能和运动表现。用手持测力计测量肩部肌肉的等长肌力峰值。通过超声成像测量肩峰肱距离、喙肱距离、冈上肌厚度和肩胛下肌厚度。六周的多模式物理治疗对喙突下撞击综合征患者是一种成功的干预措施。它改善了疼痛、功能、运动表现和肌肉力量。在干预结束时以及三个月和一年后，均观察到完全内旋时喙肱距离增加。
