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.
- Labral tear
- Rotator cuff tear/impingement
- Neural tension
- 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:
- Thoracic and cervical manipulation
- Posterior shoulder capsule mobilizations
- Cross-friction to teres minor and major
- Radial nerve sliders
- Progressive scapular strengthening
- Open-chain to closed-chain
- Mid-range to end-range
- Able to return to Jiu-jitsu and regular workout routine at 6 weeks.
ROLE OF PRIMARY AUTHOR:
Diagnosis and treatment of patient of interest.
Harris, Sean M.; Ortiz, Alexis; and Hawkins, Nikki
"Management of a Patient with an Axillary Nerve Entrapment,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2
, Article 24.
Available at: http://digitalcommons.wku.edu/ijesab/vol2/iss8/24