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.
Learn how to identify, assess, and treat foot drop in this in-depth webinar. This webinar cover causes, clinical testing, and effective treatment strategies to get patients moving again.
A little video I made showing why the ESTIM-II is better than the ESTIM-III.
Hi Doc @Exstoreman, patient presented with neck pain and twitching around scapula and tricep muscles ever since weighted seated rows at gym. The twitching is random. I’ve done exstore and cleaned up tropic changes, he had a lot between c1 to c 5 (splenus capitus). His neck is better but the twitching remains. I’ve checked for trigger points and tropic changes in the area of twitches but nothing obvious stands out. Today I went with perfusion and released neck muscles. Love your thoughts on this.
Sharing my little win treating my own right hand texting thumb yesterday with motor points for opponens pollicis, abductor pollicis, flexor pollicis. 3 needles, 5 minutes treatment with the pointer plus, slightly/very awkwardly with my non-dominant left hand :) and 85% improved today. I have just some residual ache at the 1st MCP, ulnar side. @Exstoreman what do you think of a high frequency intraarticular treatment, or what would be a good next step to get to 100%?
@BrittLeeworthy I gotta say. You been doing some awesome work with your website with your membership section. I'm loving the structure of your plans. I haven't really seen this anywhere else.
How long did it take you to come up with this structure? I been trying to come up with a concise membership plan and what you have is awesome. Just wanted to say.
