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.
Check out this clip from the April seminar where Anthony talks about lines of tension. For those who are going to the sports seminar in Mesa Arizona this weekend, you were going to learn all about these and a whole lot more. It’s content ever before taught, and will put you leaves and bounds ahead of everyone else. And the best part is, it’s not just for athletes, it’s important information for all of your MSK patients!
If you've been getting burned out, annoyed, frustrated, it's not your patients, it's you. You're probably not practicing within your passion, or at least what interests you. And you're not setting healthy boundaries.
If you took EXSTORE™, you can join the meeting this Sunday at 1:15pm EST. We're going to talk about this and how your messaging and marketing are not aligned with your passion and purpose. Register here: https://us02web.zoom.us/meeting/register/smHIUMNvTWySJCYZ75aYzA
Any information on treating tinnitus? I have had some success with reduction but would love any information on more refined techniques.
Hi Doc @Exstoreman,
Any tips for when patient presents with anterior shoulder pain. ache at night with a heavy feeling and pain on random movements especially horizontal adduction. I have two cases now - I start with exstore and correct inhibitions, clean up trophic changes, heaviness improves and the ache at night reduces a little but the impingement pain is still present. Finding it hard to shift. Grazie
