Case of the Week 5-20-12: Painful Preaching | Modern Manual Therapy Blog

Case of the Week 5-20-12: Painful Preaching

I recently saw a former patient who I knew as a runner from years back, it turns out he is a Catholic Priest, and he was excited to be treated by a Dr. Religioso!

We had no idea he was a priest asjust wore running clothes with sneaks in the past. Here's his current...

History: Insidious onset of left shoulder pain felt for at least 1 year and worsening in intensity. The Sx were felt along left upper trap, radiating to left lateral upper arm and to below the elbow in radial nerve distribution. The complaints worsen with

  • running
  • abducting and externally rotating left shoulder (he has to hold for prolonged periods saying mass)
  • sleeping on his left and preferred side
  • AROM cervical spine dysfunctional and non-painful (DN) for left > right cervical SB and rotation, sev loss left, mod loss right
  • ext mod loss, DN
  • flexion FN
  • Shoulder scratch ER DN, mild loss on left, IR DP, sev loss on left
  • myofascia: mod restrictions left cervical paraspinals > right, upper trap, levator scapula, left lateral upper arm, left bony contours of radius posteriorly
  • neurodynamics: mod loss with reproduction of complaints in radial nerve bias
Btw, my bias for cervical spine/UQ is not to perform repeated motions, I only perform for them for lumbar.

Assessment: Signs and Sx consistent with cervical dysfunction with accompanying radial neuropathic pain.

visit 1
  • IASTM to the cervical paraspinals, upper trap, levator scapula, lateral upper arm on first visit
  • instructed on postural correction, use of lumbar roll, cervical retractions and radial self tensioners
visit 2
  • 50% improvement, able to lie on left side for 1 hour, less pain with left shoulder abduction/ER in mass 
  • added FR and posterior radial bony contours FR and IASTM
  • neurodynamic tensioners with head in neutral
  • reviewed HEP
visit 3
  • 75% improvement, able to sleep all night waking with only minor L UE complaints
  • cervical ROM in SB and rotation L, now only mod loss instead of severe
  • neurodynamic mobility improved, still limited with radial bias
  • added cervical SB away for tensioner progression
  • IASTM and FR as before, added first rib mobs
visit 4
  • able to say mass 100% pain free, able to run pain free
  • no change to Tx or HEP
  • shoulder IR/ER scratch now FN
visit 5
  • still 100% 1 week between follow ups (total 3 weeks of Tx)
  • cervical ROM still DN, mos loss on left for SB, but rot is now DN, mild loss
  • bonus, he told me about lumbar and radiating LE pain which was long standing and did not mention on the eval, but that also abolished - most likely due to postural correction
  • discharged with continuing use of lumbar roll, cervical retractions, less frequent radial neurodynamics
I thought this was a straight forward example of treating the neural container with some MDT for HEP plus neurodynamics. He was also very excited that he no longer had radiating LE pain as well.


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