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.
Give this a read after you watch the video: https://pmc.ncbi.nlm.nih.gov/articles/PMC7689775/
Athletic Intensive Myofascial Release
Location: Shokunin CrossFit, Mesa, AZ
Pre-requisite: EXSTORE
Register here:
https://aseseminars.com/event/athletic-intensive-myofascial-seminar/
Is anyone practicing in area code 23062 - Virginia, or thereabouts? Williamsburg? For a friend with scoliosis and arthritis. thanks in advance.
Patient: 34-year-old female, currently 15 weeks pregnant.
Diagnosis: Ehlers–Danlos syndrome (diagnosed 2021), hypermobility type (hEDS).
Surgical history: Four right hip surgeries between 2021–2024 for a torn labrum, ultimately requiring a cadaver graft, as well as repair of a femoral head injury. All four procedures have been deemed unsuccessful. In 2022, she also underwent shoulder surgery for a labral tear.
EXSTORE findings: Weakness noted in the L gluteus maximus, R adductor magnus, R hip flexors, L serratus anterior, and supraspinatus.
Current symptoms: Significant discomfort localized to the R greater trochanter, adductors, and hamstrings, with associated low back pain.
Pain management history: Prior to pregnancy, symptoms were managed with Baclofen, which was discontinued during pregnancy and is planned to resume postpartum. She claims she has had relief from DN in the past.
My understanding is that Ehlers–Danlos syndrome is an umbrella term encompassing 13 connective tissue ...
Athlete with sub-acute second metatarsal stress fracture currently using rest and laser therapy for treatment. For electroacupuncture... Osteopuncture at 100 Hz at the base and head of the metatarsal to cross the fracture ? 30 Hz across the ankle joint at GB 40 and above the sustentaculum tali? Are MPs relevant here?
