Case Study: Shoulder Pain - SLAP Tear

This is a case of pretty severe shoulder pain that I treated over the course of 7 months.

Patient is a 38 year old male coming in for reduced range of motion and pain in right shoulder. 

Subjective:

Onset was gradual starting 5 months prior with no history of acute injury. Patient reported chronic “bad posture” and working out of his car for years. He suspected it may have been due to repetitive motion reaching to the back seat with his right arm. Started to notice the pain while throwing a ball for his dog. 

Activities of daily living impacted were putting on clothing - jackets/shirts, difficulty reaching into the back seat of his car, pain and restriction with paddling while surfing, and waking up due to pain. The patient had previously been working with a physical therapist and stretching with minimal improvement. On the advice of his PT and Primary Care Provider he had sought an MRI for further information which revealed a SLAP tear. He consulted with an orthopedic surgeon who suggested against surgery and to seek less invasive intervention. 

The quality of his pain initially was burning, stabbing, pinching sudden pain distal to AC joint of right shoulder on flexion and internal rotation of humerus. Pain dissipated quickly when he returned to a neutral position. Some stiffness reported in the mornings as well. 

Patient reported nerve pain down inner arm and forearm around a dozen times per day. Pain also radiated into lateral right neck and down into rhomboid area. Patient reported pain at a 7/10 at worst in the two weeks prior to initial visit, 1/10 at best with a constant awareness of it feeling “different than left shoulder”. 

Objective:

Range of motion of right humerus measured at initial visit: 

Abduction - 95 degrees

Flexion - 170 degrees

External Rotation - 50 degrees

Lift Off Test - Positive for pain in anterior and superior shoulder. Patient could not get his hand behind his back at all

Empty Can Test - Negative

Assessment: 

Diagnosis: MRI documented SLAP tear, suspected strain of subscapularis/ adhesive capsulitis

Chinese Medical Diagnosis: Qi and Blood Stagnation in LI/SJ/SI/Pc channels of arm and shoulder.

Treatment: 

Treatments consisted of Acupuncture (motor point and traditional point locations), Myofascial Release, Craniosacral Therapy and Cupping

Patient was treated once weekly for 8 weeks. At that point, sleep was improved but he was avoiding sleeping on right side, he was able to surf with some weakness reported in right shoulder, but no pain during or after surfing. Nerve pain had become infrequent and no longer having pinching or sharp pain in the shoulder, although pain continued to be mild and dull in quality.

We reduced treatment frequency to once every 10 days for 6 more visits. Patient reported being able to sleep on right side without pain or disruption. At that point he was able to start strengthening and was noticing mild muscular soreness, but overall was feeling good. He was still having infrequent “twinges” with certain movements, but range of motion was increasing. 

We worked together for 3 more visits. 

Range of motion of right humerus was measured at last visit: 

Abduction - 175 degrees

Flexion -  175 degrees

External Rotation - 90 degrees

Patient was still testing positive for pain in anterior shoulder with Lift Off, but he was now able to put his arm comfortably behind his back. I would have liked to have worked with him more, but he moved across the country at this point.