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....
This clip from 2017 sums up one of the biggest issues we see when treating MSK and pain conditions with needles — and also the solution.
The problem is not the lack of different techniques.
The problem is knowing when to use them, why to use them, and when not to use them.
Motor points, trigger points, electroacupuncture, peripheral treatments, central nervous system approaches — all of these can be valuable.
But they are not interchangeable.
The real skill is understanding how to apply those techniques through the lens of neurology, assessment, and clinical reasoning.
That means identifying what type of problem is actually in front of you, determining the most appropriate treatment strategy, and then reassessing to see whether you actually changed what you intended to change.
That is the difference between simply performing a technique and treating with precision.
And that is exactly what the EXSTORE™ Orthopedic System is built to teach.
EXSTORE gives practitioners a complete, ...
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.
This webinar will give practitioners the basics and a broader perspective on how to approach the mechanism of injury, formulate an assessment, and develop a solid treatment plan that includes collaboration with other healthcare providers.
📅: Saturday, August 22
⏰: 1:30pm EDT
👉🏽: Registration Required: https://us02web.zoom.us/meeting/register/ufVVcSYbSKu0jGlaJsRiuQ
Hello!
I am treating a female patient (49) with a long history of severe pain following a surgery (1988) when she was 10y to remove a Ewing sarcoma with skin and other soft tissue underneath her left shoulder blade. Although she does not have much recollection of what was done then, direct observation of her left shoulder suggests that the extensive portions of the upper and middle trapezius were removed. The skin covering the upper trapezius looks like a thin and very tense layer of skin with a thin underlying muscle sheet between the suboccipital area and the acromion.
In 2023, she was diagnosed with pancreas adenocarcinoma, and recently metastatic nodules were found in the lungs. Earlier this year, she had a surgery to her left lung to remove some nodules, and she is now undergoing an experimental medical trial related to a mutation she carries (KRAS G12D).
HER CHIEF COMPLAINT:
Severe pain and significant restriction of the left (affected) shoulder, with pain / numbness ...
Why Myofascial Release Is 1/3 of a Successful Acupuncture Visit
This Saturday at 1:30 PM, we’ll discuss why soft-tissue work can be an important part of treating musculoskeletal injuries with acupuncture. We’ll cover techniques including Gua Sha, manual therapy, and dynamic ischemic compression- and how incorporating soft-tissue release may support recovery and improve treatment outcomes.
📅 Saturday, August 15th
⏰ 1:30pm EDT
Must register to join! 👇🏽
https://us02web.zoom.us/meeting/register/Q54_nCEXTkuja2Ehlc7PfA
