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.
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Hi @Exstoreman , I have come across my first case of notalgia parasthetica . He’s has a persistent itch in the left intrascapular region at around T6 level ( about the diameter of a golf ball). It started 9 months ago after a bad sunburn. It’s not actually the reason why he’s seeing me but he mentioned he had this annoying persistent itch and that’s what I think it is. He’s seeking treatment for muscular tension in the neck and shoulders and he also suffers from cluster headaches ( hasn’t had any for 5 months). But my question is for the notalgia parasthetica: I’m using T6-9 HJJ (no estim) for that . Any other tips? Can I expect full resolution with consistent treatment?
Comment below on this post on how you're doing - and be honest! Are you feeling kind of blah about practicing? Feeling stuck? Not sure if you're bored or burned out? And are you tired of seeing certain patients, maybe you find them exhausting, but you're not sure how to say no?
It may be time to specialize. Comment below and let me know if you'd like a webinar on this. We can get you excited again to practice!
