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Here’s a fun case and self-reflection on it. (Patient and parents consented to me posting). Learn from my mistakes. (1/?)
- 17 y/o F national level archer
- 3 mo of gradual increase in L shoulder pain
- no MOI or change in activity, thinks it’s from too much archery and CrossFit
- 17 y/o F national level archer
- 3 mo of gradual increase in L shoulder pain
- no MOI or change in activity, thinks it’s from too much archery and CrossFit
Below are her objective at the end of her eval. Cervical mobs, shoulder AAROM, side lying serratus work increased AROM quite a bit. Notice pic of her rested prone. (2/?)
It was my first time seeing blatant winged scapula at rest and actively with flexion and resisted flexion. Immediately thought long thoracic nerve injury. Booked more sessions but also referred back. Original MD agreed testing should be done, and sent to our sports MD.
Our sports MD said it was scapulothoracic bursitis but agreed nerve conduction could be done to rule anything out, but likely wouldn’t change management of it. Interesting I learned that acapulothoracic bursitis was a thing first time I shadowed Brehn Pagel at residency. (4/?)
Anyhow takes forever for her to see neuro, but she achieves 5/5 MMT and full ROM within 4 weeks over 4 visits. Appears normal, just notes pain. Finally she gets nerve conduction and comes negative.
Even before I saw nerve test I messaged sports MD and told him he is likely right based on how fast she improved and thanked him for teaching me not to jump to things so quick and also that even if a diagnosis was positive it may not change management.
As for her I saw her from 11/20 to 12/30 for 7 visits. Sadly she has to discontinue since deductible is reseting. ROM and Strength measures below and QuickDASH showed 30% disability but she’s shooting the bow again since 4 months ago.
Gave her 3 exercises:
-prone Row to ER 4x6 2-3# to blast her posterior cuff
-modified push ups table height 4x3-5 because figured it was so hard for her that subscap would have to work super hard with co contraction
-scaption with bow to forehead height 3x15 because specificity.
-prone Row to ER 4x6 2-3# to blast her posterior cuff
-modified push ups table height 4x3-5 because figured it was so hard for her that subscap would have to work super hard with co contraction
-scaption with bow to forehead height 3x15 because specificity.
So anyways. Lessons, don’t get excited about seeing something for the first time and consider other diagnosis (even the rare ones). Thank people for teaching you something even if you were wrong. Insurance sucks. Amongst many other things...hope you enjoyed.
Oh and to add last, I was legit gonna let her shoot an apple off my head. She and her dad had a great sneaker collection too. Knowledge of the sneaker world never fails to build rapport.
