PTH 633 Final Project 

Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
 
Compare and contrast the two diagnoses your group was given. Consider possible 
presentations based on typical characteristics of each condition. Be thoughtful in 
your answers; forms will be shared with all classmates. Use all of your resources, 
including class notes, textbooks, journals, and other creative sources. Provide a list 
of sources used. 
 
Diagnoses  Shoulder Impingement  Biceps Tendonitis at the 
Syndrome  Shoulder 
Common age range  - Young overhead athletes   Most common in 18-35 year 
of patient  - Middle-aged to older  olds.   
individuals after activity 
increase or overhead 
activities 
Mechanism of injury  Decreased size of the  Repetitive shoulder motions 
  subacromial space can be  especially overhead motions 
due to: ​acromion type, bone spur  such as those that occur in 
formation, coracoacromial ligament  swimming, tennis, and 
hypertrophy, bursal thickening, RTC 
weakness or imbalance, poor  baseball. 
posture, GHJ hypermobility, scapular 
dyskinesis, shoulder OA, repetitive 
overhead movements, or shoulder 
compression injury. 
Co-morbidities that  - Acromion Types can  Chronic irritation from 
may increase risk  affect Primary Subacromial  trauma, forward head 
Impingement. Type 2  posture, or abnormal 
curved and Type 3 hooked  scapulohumeral rhythm.  
are most problematic.    - Shoulder Arthritis  
- Forward head and/or poor  - Glenoid labrum tears 
posture  - Chronic shoulder 
instability 
- Shoulder impingement 
- Inflammatory disorders 
Symptom  Local swelling and  - Inflammation of the long 
description  tenderness on anterior  head of the biceps tendon 
  aspect of shoulder  - Dull, achy pain on anterior 
shoulder after activity 
Pain description  - Sudden  - Tenderness in the front of 
  - Mechanical  the shoulder  
- Occasional snapping 
sensation in shoulder 
- Pain or achiness that 
moves up or down humerus 
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
Location of pain  Pain right in the deltoid,  Pain usually superficial and 
(be specific)  the deltoid tuberosity  anterior on humerus located 
referral pattern  right over the 
intertubercular groove.  
What increases pain?  - Raising the arm overhead  - Worsened with overhead 
  or out to the side.    activity or lifting 
- Pain lying/ sleeping on  - Pain with resting may 
involved side  become worse at night 
- Throwing motions or 
similar dynamic 
movements 
- Pain with PROM: 
abduction to 180°, IR, & 
horizontal adduction 
What decreases  - Ice  -Ice 
pain?  - rest  -Rest 
  -NSAIDs  - NSAIDS 
- Steroid Injections 
Common reported  - Difficulty reaching  - Difficulty lifting heavy 
functional  overhead into cupboard or  objects 
limitations  combing hair.   - Difficulty reaching 
- Difficulty buttoning or  overhead to don clothing or 
zipping up clothing  into cupboard. 
Expected  Swelling may be present  Rupture of the long head of 
observations, if any  over affected shoulder.  the biceps is known as a 
‘popeyes deformity’. The 
long head of the biceps 
bunches up distally in the 
arm.  
Expected palpation  Subacromial bursa will be  - Pain upon palpation over 
findings  warm and tender to  the long head of the biceps 
palpation.  in the intertubercular 
groove. 
- crepitus 
ROM findings;  -Decreased shoulder  - AROM painful elevation 
patterns of loss?  flexion and shoulder  arc 
abduction due to 
decreased size of 
subacromial space 
- limited active elevation 
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
Strength deficits, if  Weakness and stiffness  - Popeye deformity lose only 
any  normally found but usually  ~5% of elbow flexion 
2° to pain.  strength.   
- Do not notice any 
functional loss of elbow 
flexion strength. 
Neurological  N/A  N/A 
findings, if any 
Joint mobility testing  Inferior glide of the  N/A 
  humeral head (excessive 
translation of the humeral 
head superiorly can 
decrease the size of the 
subacromial space). 
Special tests  Hawkins- Kennedy Test,  Yergason’s Test (- for click 
  Coracoid Impingement,  but painful), Speed’s Test, 
Cross Arm Test, Neers  and Dynamic Speed’s Test 
Compression Test, Yocum, 
and Impingement Relief 
 
What are the key subjective and objective findings you would use to differentiate 
between the two diagnoses you were given? 
Subjective:  

Shoulder Impingement  Biceps Tendonitis at Shoulder 

● Painful range of motion arc  ● Achy pain that can radiate down 
● Superficial pain on anterior  the humerus 
shoulder  ● Superficial pain on the anterior 
○ pain might radiate to side  shoulder 
of upper arm  ● Potential notable snapping or 
● Shoulder may be tender to the  clicking 
touch  ● Pain with overhead arm motions 
● Sudden pain with lifting and  ● Pain with reaching behind back 
reaching overhead  ● Pain with lifting objects 
● Loss of strength   
● Pain and trouble reaching arm   
behind back 
● Pain with throwing 
● Pain at night if injury progresses 
 
 
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
Objective:  

Shoulder Impingement  Biceps Tendonitis at Shoulder 

(+) Hawkins-Kennedy=Supraspinatus  (+) Yergason’s Test= Instability 
(+)Coracoid Impingement= Structures  (+)Speeds Test= Biceps Tendinitis 
against the coracoid  (+)Dynamic Speeds= Biceps Tendinite 
(+)Cross Arm= Impingement at  **Cluster: Yergason’s and Speed’s for 
acromioclavicular joint  greater detection of biceps tendonitis 
(+)Neers Compression=Greater  pathology 
tuberosity jams into anterolateral   
acromion   
   
-Pain restricted to a certain  -Point tenderness/pain with palpation 
movement/degrees of movement  and Clicking/popping with movement  
(flexion, abduction, horizontal   
adduction)  -Able to feel tendon slip out of bicipital 
groove during movement 
 
 
 
Briefly describe your treatment strategy for each condition, including progression 
of treatment. What are the key treatment areas of focus for each condition? 
Shoulder Impingement Syndrome​: initial treatment for subacromial impingement is 
conservative management with rest, NSAIDs, steroid injections, and physical 
therapy. If non-surgical treatment fails pt. can be referred to an orthopedic surgeon.  
A. Acute phase → relieve pain/inflammation, increase ROM, reestablish 
muscular balance, posture education, and avoid aggravation 
a. Physical therapy:  
i. Work on PROM for flexion, scapular plane elevation, IR/ER at 45 
degrees of abduction, and abduction to 90 degrees 
ii. Pendulum hangs, which can progress to swings 
iii. AAROM symptom free, which pt. can perform themselves with a 
rope and pulley 
iv. Joint mobilizations - inferior and posterior glides - grades 1 & 2 
v. Isometric strengthening 
vi. Scapular strengthening - retraction, depression, protraction 
vii. Rhythmic stabilization exercises for IR/ER and flex/ext 
 
 
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
B. Intermediate phase → establish non-painful ROM, strengthening, maintain 
reduced inflammation/pain, and increase functional mobility  
a. Physical therapy:  
i. Continue to work on PROM increasing ER, IR, and horizontal 
abd/add to 90 degrees 
ii. AAROM with the use of rope and pulley  
iii. Increase joint mobilization grades to 3 & 4  
iv. Increase strengthening exercises to emphasize rotator cuff and 
scapular muscular strengthening 
1. i.e. - I, Y, and Ts with low weight, ER/IR with theraband, 
scapular retraction/protraction/depression with 
theraband, D1/D2 pattern stabilization, and wall washes 
v. Functional activities can be increased without any prolonged 
overhead activities or lifting weights overhead 
 
C. Advanced phase → improve strength/endurance, maintain ROM/postural 
corrections, continue to increase functional mobility 
a. Physical therapy:  
i. Continued PROM stretching to maintain ROM 
ii. Progress strengthening exercises by increasing weight, sets, and 
reps 
iii. Begin biceps & triceps strengthening 
iv. To progress to return to activity pt. must have full, nonpainful 
ROM, no pain or tenderness, and at least 80% strength of 
uninvolved side. 
D. Return to activity phase → initiate interval sport program and isotonic 
exercises  
 
Biceps Tendonitis​: Initial treatment is conservative with the use of rest, ice, NSAIDs, 
steroid injections (cortisone), and physical therapy. If non-surgical treatment fails 
pt. can be referred to an orthopedic surgeon.  
A. Acute phase → decrease inflammation in tendon, improve ROM, treat pain 
a. Physical therapy:  
i. Advise pt. to avoid aggravating factors 
ii. Begin PROM exercises including flex/ext, abd/add, IR/ER - be 
careful with extension so you do not over stretch this tendon 
iii. Postural corrections 
iv. NSAIDs can be taken to reduce pain and inflammation  
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
B. Intermediate phase →  
a. Physical therapy:  
i. Continue to work on PROM exercises to maintain ROM 
ii. Begin AAROM with the use of a rope and pulley 
iii. Begin strengthening exercises for the scapula (i.e. retraction, 
protraction, depression, elevation), shoulder extension, IR/ER, 
abduction/adduction  
iv. Begin AROM for shoulder flexion and forearm supination as 
long as pt. does not report pain 
v. Work on improving functional use of the arm  
 
C. Advanced phase →  
a. Physical therapy:  
i. Continue with PROM exercises to maintain ROM 
ii. Increase strengthening exercises by increasing weight, 
increasing theraband strength, and increasing sets and reps 
iii. Begin to add weight to biceps. Pain free strengthening to work 
towards progression into daily activities or sport 
iv. Increase functional activity level  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 PTH 633 Final Project 
Student Names: Megan Brow, Ben Slocum, Darie Kirschling, and McKenna Mathis 
Resources (in AMA format):
1. Biceps Tendinitis. American Physical Therapy Association. https://www.moveforwardpt
.com/SymptomsConditionsDetail.aspx?cid =6737f4e9- e8ec-43fe-b0b9-01e86354dcea.
Published December 13, 2018. Accessed April 17, 2019.
2. Escamilla RF, Hooks TR, Wilk KE. Optimal management of shoulder impingement
syndrome. Open Access Journal of Sports Medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945046/. Published February 28, 2014.
Accessed April 17, 2019.
3. Gulick D. ​Ortho Notes: Clinical Examination Pocket Guide.​ Philadelphia, PA: F.A.
Davis; 2018.
4. Nho S, Strauss E, Lenart B, et al. Long head of the biceps tendinopathy: diagnosis and
management. ​Ovid.​ https://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi?QS2=434f4e1a
73d37e8c5a069e886e3737f2ccad7e32be6cf07af691b6eafe6847ed04ca6c5c797e66eb0d5
b94f916f4f79068efba1b27f8f7ebf78fe72103d09c620da889d4f146e3f659a9cb0e95dc2d7
63d33305db3f1b591b45a73ba7efb8c6284c1d1765d36c801659c7a282b9e7de7ff837f907
227f1f34ae8e8ea4ecf9bf92bdd1c80e527cd75067f988001a45762ae30576597f0b8d308ee
8a24a80139791e0ff796de2f4c2c6708809f34e7acb050c0161a039f0c91ed16bab254dff61
6a27b0dcfa30807c6d7f66aa785ab192f3cc995f5d77f7631ec069bec53752d9979780a48c2
45dec1333a388914d1233ea4598e3830e930b0455222617aa18ee059f12ff2599efc6d.
Published November 2010. Accessed April 17, 2019.
5. Phsyiopedia Contributors. Biceps Tendinopathy. Physiopedia. https://www.physio-pedia.
com/Biceps_Tendinopathy. Published August 30, 2018. Accessed April 17, 2019.
6. Physiopedia Contributors.​ S​ peeds Test​.​ Physiopedia. https://www.physio-pedia.com/
Speeds_Test. Published August 30, 2018. Accessed April 17, 2019.
7. Shoulder Impingement. American Physical Therapy Association. https://www.move
forwardpt.com/SymptomsConditionsDetail.aspx?cid=1793961e-c552-4367-b3fb-61a146
7b7930. Published February 4, 2016. Accessed April 17, 2019.
8. Shoulder Impingement/Rotator Cuff Tendinitis - OrthoInfo - AAOS. OrthoInfo.
https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendi
nitis/. Accessed April 17, 2019.
9. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. ​Orthopedic Reviews.​
2012;4(2):18. doi:10.4081/or.2012.e18.