Case Update: The Fusion that Shouldn't Have Been
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I have now seen Mr. Fusion for two follow ups. He still has moderate intermittent right scapular pain. The cervical retractions worked to stretch his severely restricted OA, but overtime worsened his scapular complaints. On follow up 1, I modified it to OA nodding only, as in this video. TASTM was performed to right upper trap, levator scapula, and right > left cervical paraspinals. He left feeling better, but pain was not abolished.
On Follow up 2: No change. The scapula setting exercise was corrected as he was not depressing his scapula enough to inhibit his upper traps. Manual therapy was the same TASTM with added subcranial shear distraction. If no change is seen by follow up 3, I am going to look more at his thoracic area and incorporate TASTM and JM if needed. Why haven't I looked at this yet? Since the cervical spine can refer to as low as T6, I try to treat only as few areas as needed otherwise you end up "chasing the pain" so to speak. Lastly, the patient also reported his Sx being reproduced by push ups, but not any other exercise. This is possibly due to excessive cervical protraction; he mentioned it at the end of the visit, and I didn't have time to watch him perform it to observe his form.
I will keep you updated on his progress!