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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Awesome first day back at clinic. Got to use many of the techniques from over the weekend with emphasis on finishing with body work. Everyone had improvement today but the bodywork on top especially with pin and stretch serratus area really opened up people.
Arm pain, biceps ( from repetitive stress / vaccum for job, MSK with underline chronic digestive issue and headache )
Topic: arm pain
Presentation : MSK arm start 1 year ago worse with moving and foot external ( + sistemic, DI impacted, headaches)
Scan result : ROM CSPINE LF limited. MT RG deltoid front and lateral , LF supraspinatus and serratus
Treatment : perfusion cervical , activate infra and serratus and upper trap, restore line tecnique biceps
Outcome : ROM C SPINE improved , MT strenght improved on all
Follow up : twice a weeks two weeks, didn’t do manual technique, didn’t give exercise , taped scapula ( leku and protective) made pattient retract scapula ( where can find more content for taping? ) , herbal patch on biceps
Challenges : amount of notes, time management,perfusion on side line ( prop tend to fall) bigger patient and sensitive, can't see muscle moove and patient don’t feel comfortable with muscle jump. Not sure how classify this patient , there is systemic ...
1) after trauma patient reported pain on the RG front arm and neck pain 8on10. MSK presebtation. Did the Scan limited ROM C-SPINE BI 25RG /30LF, limited GH joint RG 100, ST joint RG 30. MT RG suprispunatus and serratus inhibited .Activated with pointer plus infrasp, searratus, wasn’t able to target the levator scalens got activated instead. Did perfusion upper back 20 min, 20 frequency.
Outcome: ROM incresed GH and ST joint not much at C -SPINE.
Challenges to report : find levator scapula point, time Managment.
Follow up : ask patient to return twice a week for 2 weeks. To do list : re-do Scan upper ext., continue perfusion( All visit?) , restore line tecnique on brachialis, other to suggest ?
Thanks
