A 51 year-old very active man presented with shoulder pain after being diagnosed with both a rotator cuff tear and long head of biceps tear. His discomfort wasn’t limited to his arm. He felt pain in the neck and back as well. Furthermore, he was having trouble sleeping at night and was experiencing numbness in his fingers.
Evaluation, clinical reasoning & treatment strategizing
Neuromuscular Therapy worked in with his Physical Therapist to coordinate care. Our combined goal was to reduce muscular-sourced pain, strengthen his shoulder and prevent a surgical intervention. Our treatments eventually plateaued. The patient consulted with both a neck specialist and a pain care specialist to rule out cervical involvement leading to finger numbness. Ultimately he decided to have the rotator cuff repair surgery. The surgery was successful for the very large tears found in the supraspinatus and infraspinatus muscles.
After the surgery NMT was focused on a spasm that had developed at his neck/shoulder junction. His levator scapula and upper trapezius were constantly painful, which the patient attributed to the time he had spent in a sling. The serratus posterior superior muscle (a muscle often involved in deep, enigmatic upper back pain) was found to be highly involved and releasing trigger points in this muscle greatly reduced pain. He continued with post-operative PT and NMT once-weekly for nine weeks.
Results and follow-up
While this patient ultimately needed a cuff repair, NMT was utilized both before and after surgery to optimize Physical Therapy outcomes and reduce pain. The patient is returning to full functionality and continues with maintenance NMT every three weeks.