A multi-modal treatment approach for the shoulder: A 4 patient case series
A multi-modal treatment approach for the shoulder: A 4 patient case series
Published online 2005 September 16
Received September 6, 2005; Accepted September 16, 2005.
Mario Pribicevic1 and Henry Pollard2
Chiropractic & Osteopathy
PubMed Central

1Macquarie Injury Management Group Department of Health and Chiropractic Macquarie University, 2109, Sydney Australia
2Macquarie Injury Management Group Department of Health and Chiropractic Macquarie University, 2109, Sydney Australia
Corresponding author.
Mario Pribicevic: mariochiro@optusnet.com.au; Henry Pollard: hpollard@optushome.com.au
Received September 6, 2005; Accepted September 16, 2005.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background
This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach.

Clinical Features
Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities.

Conclusion
This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.

Keywords: Shoulder, Impingement Syndrome, Multi-modal Treatment, Chiropractic

Copyright © 2005 Pribicevic and Pollard; licensee BioMed Central Ltd.

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