Aloha @Exstoreman and team!
Happy New Year!!
Last week, a patient presented with what sounded like symptoms of a stinger/brachial plexus after a chiropractic adjustment (see below). I'm reaching out because it's not responding as I'd expect to what seems to be the appropriate treatment. Pain seems to be temporarily relieved and then increasing significantly again. ROM seems ok, with slight reduction in abduction on affected side vs unaffected. Recommended to get imaging of shoulder and neck, as well as blood test for inflammatory markers (recently was told white blood cell count was high, potentially because of pain). Any thoughts/insight would be appreciated.
38F with history of L-sided neck/shoulder pain/stiffness since 2021
PT and other treatments haven't helped significantly or provided lasting change. Went to chiro for adjustment for neck pain end of Decmeber 2024. After, extreme pain and immobility of the L arm/shoulder for almost 2 weeks.
"I feel the pain along my cervical spine on the left side of my neck, shoulder, and shoulder blade, radiating down into my left arm and hand. It’s a combination of severe pinching pain and a deep, aching sensation. The pain is constant, but the intensity increases throughout the day, especially when sitting, lying down, or doing basic activities like brushing my hair or putting it up. It feels like the muscles around my shoulder blade and in my bicep are going to tear. The pain becomes excruciating when I cough or sneeze, as it feels like my muscles are about to tear. I also have difficulty sleeping due to the discomfort, as finding a position that doesn’t aggravate the pain is challenging."
OBJECTIVE
Exstore: cspine ROM (all but R rot limited, L rot/lat flex worst); L - delts (all)
Tender to palpation: SCM, upper trap, scalenes
PLAN
PP: L - SCM, upper traps
ITO: L - cplexus, brachial plexus @2Hz/10min
STR: cplexus; L - subcoracoid, subclavicular, LS, sidelying facet
TDP: neck/L shoulder (10min)
REASSESS
Subjective: Less pain rotating neck, no pain raising arm and can put up hair; shoulder feels stronger
Objective: delts ^ 300%, cspine rot (L) ^ 35-40 degrees, flex ^ 10-15 degrees
2nd Visit
No pain for 2 days, then returned this AM; very sharp pain, burning around scapula (L)
OBJECTIVE
MMT: lat delt (ant/post UNR)
PLAN
PP: LS
ITO: lat delt, brachial plexus @2Hz/10min; C1-7 @2Hz/15min
Perfusion: UE 15min
STR: cplexus; L - upper trap, LS
RedLight: L - shoulder/neck (10min)
REASSESS
Subjective: tightness near spine (level of C4-6) when rotating neck L
Objective: delt ^ 150%
3rd VISIT
SUBJECTIVE: from shoulder down to elbow, feels like arm is cramping
more painful when bending over
can also feel soreness from elbow into hand a little
also has pain along left side of spine/upper shoulders/neck
pain @ 10/10
can’t raise arm to put up hair
feels like deltoids are gonna be torn off when bending over
OBJECTIVE:
TTP: post delt, triceps, brachial plexus
PLAN
ITO: L - delt (post), tricep, brachial plexus, cplexus, spinal accessory N @2Hz/10min
Perfusion: UE 18min
STR: L - cplexus, subcoracoid, supinator
REASSESS:
Subjective: pain down by 2 points (8/10); still feels like deltoids gonna tear off when bending over
Objective: able to put hair up and put sweater over head
4th VISIT (today)
SUBJECTIVE:
left last visit with pain @ 8/10 (slightly improved vs 10/10 when came in) and went down to 4/10 with ice and heat
went to work and pain increased again
feeling pain into thumb and index finger (dorsal aspect) for first time
whole area of scapula painful, including side of neck
side of neck (pointed to region of LS, brachial plexus) tender to touch, even just grazing it (LS, specifically)
confirmed that infraspinatus and scalenes TrP patterns match pain
OBJECTIVE:
Palpation @ infraspin replicated and increased pain
MMT: SA
PLAN:
PP: L - infraspin, scalene, SA
ITO: InLT: LS (2NT @ spine of scapula) @2Hz/8min; C5-7 @2Hz/15min
Perfusion: UE 15min
DN (pecking): L - infraspin, scalene
STR: L - SA (only slightly, as abduction leading to pain in top of shoulder)
RedLight: L shoulder/neck
REASSESS:
Subjective: feels like really bad charlie horse in entire shoulder blade, deltoid
Objective: SA ^ 150%
While she didn't present as chronic-systemic, the response to today's treatment and the fluctuating pain makes me think that she may be and/or that this is the acute phase of adhesive capsulitis. I'm really not sure what to think of this case....
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CC: foot pain
Pea-size nodule on the top of the foot (see image attached - area of discomfort circled in red). Pain is excruciating when applying gentle pressure on it - even gentle palpation will cause 3/10 discomfort. Cannot wear shoes that rub on it because he will get sharp pain.
Nodule appeared after bumping the top of the foot on the bottom lip/ledge of a cabinet about 5-6 yrs ago.
Doesn't have a history of hip, low back, leg issues on the affect side of the foot.
He's seen a foot doctor that diagnosed him with arthritis and told him he has to live with it.
I had a consult with this person so not yet a patient. Is this something that can be treated with acupuncture. He's looking for pain relief.
What do you think @Exstoreman?
I have a few patients (desk workers) who tend to get that thoracic ribheads slipping out of place causing stabbing back pain. I know a PIR technique to correct it, and I work on the tight thoracic muscles. Apart from encouraging the person to lie in a supported arch position (on a ball or a spine deck), Would rhomboid and/ or lower trapezius exercises be good homework? What else can the patient be doing to prevent this from recurring? @Exstoreman
Similarly, I have a patient who comes in every other week (maintenance of chronic low grade knee pain, and a chronic R hip pain that she describes as near the ischeal tuberosity and upper inner thigh / adductor region. R STL is always tight, and something generally tests weak each time (it could be lateral abductors, adductors, psoas, glut max, TFL -- I've treated it all.) She always responds really well and feels great for awhile, but that nagging adductor pain has been persisting intermittently for years. I generally treat both the hips ...
