Shoulder Impingement Syndrome Associated with Low Thoracic Kyphosis and Intrascapular Myofascial Trigger Point in a 25-Year-Old University Student: A Case Study

Naeem Ullah; Adnan Khan; Huma Khan; Salman Khan; Abdul Malik; Amin Ullah

doi:10.55735/vze4hv37

Authors

Naeem Ullah My Health and Wellness Center, Peshawar, Pakistan https://orcid.org/0009-0005-4604-4740
Adnan Khan My Health and Wellness Center, Peshawar, Pakistan
Huma Khan Sarhad University of Science and Information Technology, Peshawar, Pakistan
Salman Khan Irfan General Hospital, Peshawar, Pakistan
Abdul Malik City University of Science and Information, Peshawar, Pakistan
Amin Ullah Department of Physiotherapy and Rehabilitation, Ibadat International University, Islamabad, Pakistan

DOI:

https://doi.org/10.55735/vze4hv37

Keywords:

Myofascial trigger points , Overhead activity , Shoulder dysfunction , Shoulder impingement syndrome , Thoracic kyphosis

Abstract

Background: Shoulder impingement syndrome is a common cause of shoulder pain and dysfunction. Flattened thoracic kyphosis may limit scapular posterior tilt and upward rotation, while intrascapular trigger points can increase pain. This case highlights their combined role in impingement syndrome. Objective: To present the clinical features, management, and outcomes of a patient with shoulder impingement syndrome associated with reduced thoracic kyphosis and interscapular myofascial trigger points. Case Presentation: A 25-year-old male student reported 8 months of non-traumatic left shoulder pain aggravated by overhead activity and prolonged sitting. Postural assessment showed reduced thoracic kyphosis and mild shoulder protraction. A trigger point at the inferior-medial border of the left scapula reproduced local pain. Examination revealed a painful arc (70-120°), positive Neer’s and Hawkins-Kennedy tests, mild external rotator weakness, and decreased scapular posterior tilt. This syndrome was linked with thoracic hypokyphosis and an intrascapular trigger point was diagnosed. A multimodal physiotherapy plan was initiated, including thoracic extension mobility exercises, ischemic compression, scapular stabilization, rotator cuff strengthening, and ergonomic advice. Over 12 weeks, the patient showed reduced pain, improved range of motion, better thoracic extension, and enhanced function. Trigger point tenderness decreased, and scapular kinematics normalized. Discussion: This case highlights the complex relationship between thoracic spine alignment, scapular mechanics, and impingement syndrome in a young adult. The patient presented with low thoracic kyphosis, intrascapular myofascial trigger points, and symptoms consistent with impingement syndrome. Most existing literature has focused on the impact of excessive thoracic kyphosis on shoulder dysfunction. Conclusion: This case emphasizes that low thoracic kyphosis and intrascapular trigger points can play a contributory role in SIS, especially in young adults. Addressing thoracic posture, myofascial dysfunction, and shoulder mechanics through a comprehensive rehabilitation approach can lead to significant clinical improvements.

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