This 42-year old lady presented with anterior shoulder pain during tennis serve when hitting the ball at full elevation. She started again playing tennis after a 10 year stop, experienced pain but continued untill pain was also present in activities of daily life. She had one corticoid infiltration that reduced pain in ADL but during tennis serve the pain remained present.
In clinical examination we retain:
- stiff posterior shoulder muscles with 14° GIRD – 16° TROMD
- Strenght deficit right to left of 14% for ER90 – strength gain of 16% for IR90
- limited ROM of scapula to posterior tilt/retraction
- stiff pectoralis minor
She performed an exercise program based on these findings and interestingly, pain during serve could be immediately changed by correction from a kinetic chain perspective. We aim to decrease the amount of strength and mobility required from the glenohumeral joint by:
- increase of hip, trunk and thoracic spine
- increase of scapula retraction posterior tilt to position the glenoid more posteriorly. This results in less horizontal abduction needed from the humerus to reach the same point with the racket PLUS ensures better alignment of the humeral head to the glenoid with maintaining the center of rotation.
When she starts tennis serving motion with these corrections she reaches full elevation with the racket without pain.
Nice example of how the search for symptom modification during the painful activity is crucial for pain relief and prevention.