David stover cs2

1. David Stover. Case Study 2
1. Do you think that this patient has primary impingement, secondary impingement, or
both? Please explain your answer. This patient presents with primary impingement.
The reason for this is because he has decreased strength in the humeral head depressors,
decreased flexibility(capsular tightness), poor posture leading to crowding in
subacromial joint space, and a history of previous impingement.
​2. List and describe the manual and therapeutic exercise techniques that you would use
to restore the (R) scapula to its normal resting position.​ Improve postural position.
Stretch anterior muscles (pectorals, ant deltoid, biceps, ant thorax). Strengthen scapular
retractors (rhomboid, low traps, mid trap), strengthen external rotators, upper trap,
levaor scap, serratus. Using exercises such as doorway stretch, biceps stretch, scap
PRE's, theraband retraction and bilateral external rotation. Having him ergonomicly
assess his desk position at work.
3. List and describe the manual and therapeutic exercise techniques that you would use
to restore the ROM to the (R) shoulder.​ Manual exercises include PROM involving
flexion, scaption, abduction, IR, ER; joint mobs. Therapy exercises would include
AROM stretching in supine with wane into flexion and external rotation, sleeper stretch
for internal rotation, seated cross body posterior cuff stretch, pulleys for seated flexion,
scaption, and abduction. Doorway stretching for pectorals and biceps.
4. Your patient is ready to begin a strengthening program. What muscle groups would
you begin with and why?​ Scapular stabilizers. Addressing the scap stabs first are most
important due to the function of the shoulder. The shoulder needs the scapula functions
properly before the rest fall into place. These smaller intrinsic muscles help the larger
muscle groups function more efficiently. Along with scap stabs I would initiate the RTC
muscles. Getting the scapula in the proper position working symmetrically with the
rotator cuff will improve the movement of the shoulder and decrease the likelihood of
impinging on the AC joint.
5. The P.T. asks you to instruct the patient in joint protection techniques that are
appropriate to his diagnosis. What instruction would you give to this patient to protect
his injury site?​ Avoid overhead activities, avoid sleeping with arms overhead or on the
affected side, work on postural improvement, cont with stretching/strengthening
program, no repetitive work, Avoid holding your arms in one position for prolonged
periods of time, particularly in a raised position.​Particularly avoid activities requiring
abrupt back and forth movements. Use long sweeping, circular motions in activities
such as washing car, washing windows, dusting.​ If you must do repetitive activities,
make sure and take scheduled breaks.
6. The patient has also developed complaints of lateral epicondylitis (R). Describe the

2. therapeutic exercise program that you would develop to address this diagnosis.​ Begin
with AROM stretching of wrist/forearm muscles specifically wrist extensors.
Strengthening of those same muscles. Work modification with keyboard/hand
placement. Modalities to decreases pain and inflammation, cross friction and STM to
lat epi and extensors. Possibly bracing.
7. Instruct your patient in protection techniques to decrease the risk of the lateral
epicondylitis occurring again. Modify work. Check ergo with desk. No repetitive
movements or static holds. Bracing. Keep up with exercise program and ice after
overuse.