Shoulder Posterior Impingement – Patient Anonymous

Diagnosis:

Left shoulder posterior impingement confirmed by MRI, with associated supraspinatus and subscapularis tendinopathy. The MRI also shows that two important shoulder tendons — the supraspinatus (on the top of the shoulder) and the subscapularis (in the front) — are strained or irritated. This is known as tendinopathy, which means the tendons are damaged or worn, usually from overuse or repetitive motion.

Background:

The patient began physiotherapy with us on 3rd March 2025 following a corticosteroid injection administered by a consultant orthopaedic surgeon specialising in shoulder and elbow conditions. Due to the recent injection, initial treatment was limited to manual therapy and interferential electrotherapy, avoiding aggressive rehabilitation in the early phase.

Treatment Progression:

As symptoms gradually improved, further assessment revealed posterior capsular tightness — a common contributor to shoulder impingement. A tailored sleeper stretch program was introduced to specifically target this restriction and improve posterior joint mobility.

By mid-April, once it was safe to do so, we initiated Radial Shockwave Therapy (RSWT) to promote tendon healing across the rotator cuff. After three sessions, progress plateaued, prompting a trial of Focused Shockwave Therapy (FSWT) — a deeper, more powerful modality ideal for targeting chronic tendon pathology.

The patient was treated under a private health insurance policy and paid an excess for access to this specialist treatment.

Outcomes:

Focused Shockwave Therapy proved highly effective, resulting in marked improvements in pain, mobility, and muscular strength. This was especially significant given the complexity of the case.

At the start of treatment, the patient struggled with everyday tasks, particularly overhead movements and lifting even light weights in the gym. He has since returned to gym-based training, following a specific strengthening program, and reports a 90% improvement in symptoms. He is now nearing the completion of his rehabilitation.