We're joined by Dr. Chris Garcia from Chris Garcia Academy. He works with pro athletes and also teaches PTs to be at the top of their game when it comes to treating this unique population. His story is a cautionary tale about working with high level athletes prior to competition. 

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Andrew discusses a recent case with a curious finding. Bilateral Infraspinatus atrophy one side greater than the other. No myotomal or dermatomal overlap, no pain, no trauma or recent infection. What do you make of it? Any similar cases in your experience?

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⁠The Eclectic Approach Network⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.

Check out ⁠EDGE Mobility System⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

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Andrew Rothschild is back with an interesting case of severe pain and hyperalgesia around the scapula area in a CrossFit Athlete. This is the second time in 1 year after good resolution the year prior. Both times there was no clear cut mechanism of injury. Then randomly on social media, Andrew saw two posts regarding a differential diagnosis of severe pain in this area in overhead athletes. Treatment ended up being the same, but it makes for interesting discussion on how and why these things may happen. Ever seen a case of nerve entrapment like this?

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Curv Health - Start your own Virtual Clinic Side Hustle for FREE! Create your profile in 3 minutes, set your rates, and Curv will handle the rest! From scheduling to payments, messaging, charting, and a full exercise library that allow for patient/clinician tracking, it's never been easier! Click to join Dr. E's new Virtual Clinic Collective to help promote best online practices. 

Keeping it Eclectic...

Can you go to bed and wake up with a spontaneous brachial plexus injury? Have you ever been blindsided by a patient's medical history update they neglected to mention after several visits? Luckily there is a happy ending to this Untold Physio Story with Dr. Brett Scott.

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Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+

INTRO:
Non-traumatic rotator cuff tear is a common shoulder problem which can be treated either conservatively or operatively. Kukkonen et al. (2021) investigated the difference between clinical and radiological 5 year outcomes in patients aged over 55 years.


METHODS:
180 shoulders with symptomatic, non-traumatic supraspinatus tears were randomly assigned to:

1. Physiotherapy (Group 1)
2. Acromioplasty and physiotherapy (Group 2)
3. Rotator cuff repair, acromioplasty and physiotherapy (Group 3).

Primary Outcome:
Constant score.

Secondary Outcomes:
Visual analog scale for pain and patient satisfaction.
Radiological analysis included evaluation of glenohumeral osteoarthritis and rotator cuff tear arthropathy.

RESULTS:
The average tear size of the supraspinatus was 10 mm in all groups.

There were no significant differences in the average change of Constant score:

• 18.5 points in Group 1
• 17.9 points in Group 2
• 20.0 points in Group 3.

There were no statistically significant differences in the change of visual analog scale for pain and patient satisfaction. At follow-up there were no statistically significant differences in the mean progression of glenohumeral osteoarthritis or cuff tear arthropathy between the groups.

CONCLUSIONS:

• Operative treatment was no better than conservative treatment with regard to small non-traumatic single tendon supraspinatus tears in patients over 55 years of age.
• Operative treatment does not protect against degeneration of the glenohumeral joint or cuff tear arthropathy.
• Conservative treatment is a reasonable option for the primary initial treatment of this condition.

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SOURCE:
Kukkonen et al. 2021.
OPERATIVE VS. CONSERVATIVE TREATMENT OF SMALL NON-TRAUMATIC SUPRASPINATUS TEARS IN PATIENTS OVER 55 YEARS. Journal of Shoulder and Elbow Surgery

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 

Want to learn more or contact him?

Reach out online:

@physicaltherapyresearch

@Grapplersperformance

www.grapplersperformance.com

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Andrew reviews a recent case of shoulder pain that he thought may have been a frozen shoulder. However, when he attempted to palpate the humeral head, he couldn't find it!

 

Untold Physio Stories is sponsored by

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Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual

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