Case Study: Rotator Cuff Impingement Syndrome

History and Subjective Complaints:

A 24-year-old professional/international circuit tennis player presents with a right shoulder injury, 6 months post U.S. Open.

Objective Findings:

Decreased right shoulder flexion, abduction and external rotation.


Absent 8-10 mm subacromial space, laterally rotated vertebral border of the right scapula, antetilted glenoid labrum.


Protracted laterally antetilted right scapula causing rotator cuff impingement syndrome.


Specialized manipulative decompression of involved protracted/antetilted right scapula, medial-inferior sternoclavicular joint and anterior-inferior medially rotated right humerus (Mally Technique)


Anti-inflammatory vitamins (bromelain, papain, trypsin, chymotrypsin, bioflavonoids) and vitamin B6.


6 weeks of reconstruction and work hardening, rhomboid and deltoid strengthening.


Failed post-op impingement surgery is very high, with misdiagnosis and connective tissue hyperplasia the highest cause of failure. Misdiagnosis leads to erroneous results and, in this case, permanent disability and loss of dominant shoulder motion. Post chiropractic extremity manipulation by Dr. Mally yielded a return to the tennis courts and a very excited world-class competitive athlete.

For more information, Dr. Mally can be reached by e-mail at [email protected].

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