A 15 year old girl developed R shoulder pain one year ago after sleeping on it weird. Pain is constant and unable to raise hand above shoulder height (for instance raising her hand in school to ask a question).
3 months after the onset she had a diagnostic ultrasound which found a small supraspinatus tear (rotator cuff muscle). She then had 24 physical therapy visits over 12 weeks with no improvement. 2 months later she had a shoulder MRI - this did NOT show a supraspinatus tear.
11 months after initial onset the patient was referred to me. Pain was still constant (10/10 on VAS) EXSTORE exam was as follows:
•unable to flex shoulder above 90 deg on R
•scapular stability (serratus anterior) on R is inhibited
•during testing of serratus anterior upper trapezius is in spasm
•c spine ROM to the left is 45 deg
•patient cannot do any pushup or modified pushup in school gym class.
•Patient is afraid of needles.
TREATMENT
•the patient agrees to only one needle with some convincing from her mother but does NOT agree to Pointer Plus stimulation.
•I insert needle into serratus anterior with a twitch response - and leave for 30 seconds then follow up with some manual fascial release to the mid axillary line.
RESULT
The patient was off for Christmas for 2 weeks and when she returned she reported her shoulder was 80% less painful (2/10 of VAS)
•shoulder flexion improved to 170 degrees and the scapular stability was 100% stable on EXSTORE re-exam. Her c spine ROM was now 80 deg rotation bilateral.
DISCUSSION
Being specific with your assessment will pay dividends. Take diagnostic imaging into consideration but do not lean on it - do a functional exam. For a joint to move you need two things: muscles to stabilize the joint being moved and muscles to do the moving. This is why learning to assess and treat the serratus anterior is non-negotiable when aspiring to become consistently proficient in treating shoulder and neck dysfunction. This girl had 24 visits with another therapy. 24 visits! Clearly those therapists didnt know what they didnt know. We have the tools and its easier than you think folks.
Here is the list of webinars in the library.
This does not include the recorded labs or the other webinars annual members get.
@Exstoreman @JoshuaSwart Sorry, quick follow up on my post from a couple of weeks ago on pubic pain. Anthony, you mentioned a video in which you talk about treating the pudendal nerve. I have the majority of your recorded webinars and I cannot for the life of me find it in any of them. Do either of you guys happen to remember where that treatment is located? Thanks!
Patient: 52-year-old male
Diagnosis: Pelvic fracture 3 days ago (confirmed on X-ray; image attached) opposite to prothesis.
Current Status: No orthopedic follow-up yet. Was advised to weight-bear immediately post-injury and has continued to do so within pain tolerance using assisstance. Although he is feeling unsure about appropriate activity levels and has a delay in talking with GP or ortho for a few more days. My thoughts are to get up and weight bare every hour or so to help with circulation within pain free levels, ankle pumps while resting, topical linaments... Any other thoughts or tips? @Exstoreman - also is the fracture just at that upper illiac region, or is there more?
