Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain.

STUDY DESIGN Case report. BACKGROUND Based on our assumption that subtle deviations in the precision of shoulder movement cause tissue injury, we have developed a set of movement-related diagnoses for shoulder problems. The purposes of this case report are to (1) illustrate the use of a movement system impairment (MSI) diagnosis in a patient with shoulder pain, (2) illustrate how the MSI diagnosis guided treatment prescription, and (3) describe the outcomes of treatment based on a MSI diagnosis for shoulder impingement. CASE DESCRIPTION The patient was a 46-year-old female with recurrent right-shoulder pain of 2 months' duration. Initially she reported that her pain was constant but varied in intensity and had increased gradually over time. Shoulder pain limited her ability to bicycle and perform reaching movements. The systematic clinical examination for assessing the patient's preferred alignment and movements included items related to pain, alignment, movement, muscle length, muscle strength, and function. Based on the examination, the MSI diagnosis was humeral anterior glide with scapular downward rotation. The treatment focused on correction of her shoulder alignment, functional movements, and associated impairments of muscle function. The patient was seen 4 times in 6 weeks. OUTCOMES The patient was pain free with all activities at 1 month and there was no recurrence of symptoms 3 years after the last physical therapy visit. DISCUSSION A MSI diagnosis of humeral anterior glide with scapular downward rotation guided physical therapy treatment and resulted in positive short- and long-term outcomes.