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Abstract

HISTORY: A 27-year-old male reports to physical therapy evaluation with R shoulder pain following an injury during Jiu-jitsu 4 weeks prior. He experienced immediate onset of pain following a submission attempt where his arm was forcefully externally rotated. At time of evaluation, he experienced pain with pressing and pulling exercises in R shoulder that would sometimes radiate down to posteriolateral arm. PHYSICAL EXAMINATION: Initial examination of the R arm revealed hypomobility throughout thoracic and lower cervical spine, tight posterior shoulder capsule with anterior humeral head migration, and limited shoulder ROM secondary to pain. Neural testing resulted in + radial nerve tension, which was reduced with head-tilt, indicating proximal facilitation. His rotator cuff strength was strong and pain-free. He had extreme tenderness to palpation and reproduction of arm symptoms over axillary nerve in quadrangular space.

DIFFERENTIAL DIAGNOSIS:

  1. Labral tear
  2. Rotator cuff tear/impingement
  3. Radiculopathy
  4. Neural tension
  5. Axillary nerve entrapment

TESTS AND RESULTS:

R shoulder AP and lateral radiographic views

  • Bony structure and alignment intact

FINAL WORKING DIAGNOSIS:

R axillary nerve entrapment with C5-6 facilitation resulting in “double crush”

TREATMENT AND OUTCOMES:

  1. Thoracic and cervical manipulation
  2. Posterior shoulder capsule mobilizations
  3. Cross-friction to teres minor and major
  4. Radial nerve sliders
  5. Progressive scapular strengthening
    1. Open-chain to closed-chain
    2. Mid-range to end-range
    3. Able to return to Jiu-jitsu and regular workout routine at 6 weeks.

ROLE OF PRIMARY AUTHOR:

Diagnosis and treatment of patient of interest.

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