Multimodal Physical Therapy Management of Subcoracoid Impingement: A Case Report With One-Year Follow-Up and Ultrasound Measurement of Coracohumeral Distance

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.