Repetitve strain of Scapular Protractors

Chronic strain of the scapular protractors

My Subjective findings
He is young (22) male junior Dental Health professional, his c/c is pain over the right lateral upper ribs and sometimes to the same side of his mid back and medial border of the arm, also when it’s at worse state it’s accompanied by difficulty of taking air in and expanding of his chest wall, he started to appreciate the pain almost 4 yrs back with out any history of injury or brief day of onset, gradually the pain intensity and recurrence was getting worse.

The pain is triggered and reproduced during cold weather and high work load also long period of PC manipulation, while, the pain is calmed by taking rest and superficial hot applications, previously he had visited an internist for many times but there was no tangible findings within his chest cavity and other suspected systems. Hence the physicians suspected it could be some sort of somatogenic disorders and they just tried to advise him that there is no problem with his body, which doesn’t work. Of one of the physician he visited (2 years back) suggested that he could be allergic to cold and recommend him to avoid cold exposure and use hot pack and analgesics during the symptomatic phase and until now he uses this method to calm the pain which doesn’t last for long.

Objective findings

Observation and palpation
• On posterior view the right side (painful one ) inferior angle and medial border of the scapula is elevated(winged), the ipislateral paraspinal musculatures look tense when compared to the opposite one.
• On anterior view the painful side shoulder blade looks anteriorly rotated and protracted
• On plapation there is grade 1 tenderness at the right part of the Trapezius insertion and origin, Rhomboids, Infra scapular m.m, while Grade 2 tenderness is noted at the Pectoralis minor, Serratus anterior and Latissumus Dorsi bellies.

Range of motion
• All active range of motions of the shoulder and neck are full and pain free.

Resisted Isometric Testing
• Resisted shoulder blade protraction and GHJ adduction is painful.

My Diagnosis
• Chronic repetitive strain of the Right scapular protractors probably secondary to repetitive micro trauma due to his working environment.
My plan

• To facilitate scapular stabilizers against the rib cage
• To diminish the over activity of the scapular anterior rotators
First phase Intervention

• On four kneeling active protraction by pressing the torso up high 10*each 3/ 2*per day, which stimulates the scapular stabilization against the rib.
• One arm raise to ear level 10* each 3 times/ 2* per day, inorder to stimulate the lower fibers of Trapezius while simultaneously stretching the protractors.

Please I need your urgent suggestion and comment, I would be happy if you also indicate or attach any reference written materials.

have a check the thoracic outlet syndrome,

Clear his neck - ensure it isn't referred. Otherwise it sounds good what your doing.

Tailool,

He has no picture of neuro vascular insufficiency in the affected side UE.