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.
If you treat patients with plantar fasciitis, this video is worth your time. Anthony breaks it down with key treatment targets you might be missing.
Register for the next EXSTORE course or book a refresher if you need to brush up:
https://aseseminars.com/event/the-exstore-orthopedic-system-for-dry-needlers
Kenny Easley, Hall of Fame defensive back in the NFL passed away yesterday at the age of 66. He had to retire retire early because team doctors were giving him an absurd amount of nonsteroidal inflammatory drugs, which caused him to go into kidney failure and retire before the age of 30. Check out this excerpt of a New York Times article based on a piece written in a journal back in 2002. It’s important for athletes at all levels to have their own physicians and healthcare professionals so that they can act independently in the best interests of the athlete.
Post COVID, post stroke weakness & mobility issues
So this case was going well. I got strength back in her legs and arms and she was holding all progress for a few treatments even within the first few visits. Gait was looking even and lower body exstore was testing well.
Imaging shows she has brain atrophy and also lacunar infarcts though recently so I'm unsure how much more I can do without medication changes or treatment for that. Her doctors also think she may be going through some form of dementia when they ran testing but the patient could not state besides them talking about early dementia.
I am continuing with normal treatment. There is no treatment plan from any of her other doctors besides just run more tests by a new neurologist but nothing yet besides physical therapy. She has had two falls since beginning and the first one she has no memories of.
Do you think I'll continue to get back and forth until they figure out the brain? I think the areas affected can also affect ...
