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.
Anthony chronicled his 51-patient day.
No matter how many patients you want to see, how many days a week you want to work, whatever your goals are...EXSTORE™ gives you the ability to see more patients in less time while getting even better results.
You can see as many patients as you want if you learn the Exstore system to the level that you master it. And the best way to master it is come to the clinical intensive this October. There’s two spots left and there’s nothing that can replace this intensive learning experience . You will treat over 60 patients in two days. There’s nothing else like it and no other instructor anywhere in the world is offering anything close to this.
Join us this Saturday for a free webinar for post shingles pain: Assessment, Pathophysiology and Evidence-Based Acupuncture Management. This webinar is followed by live lab!
📅: Saturday August 8th 2026
⏰: 1:30pm EDT
Must register to attended:
https://us02web.zoom.us/meeting/register/EXweYis1QvOvmayxF_sVSw
I have a patient who had a spinal stroke at C3-4. He has numbness and tingling through his left arm and leg, weakness in left glutes. I have done upper and lower perfusion treatment on him twice a week for the last 3 mos. He has had some improvement. Should I also be doing any local channel points, scalp points? Anything else other than perfusion?
There are 2 seats left in my Clinical Intensive this Oct 3-4 at my office. Read the outline and register here:https://aseseminars.com/event/clinical-intensive-training-course-at-dr-lombardis-clinic-in-hamilton-ontario-2/
