Difficult Shoulder Case

Bodymattersuk

Mentorship Member
Joined
Nov 23, 2020
Messages
6
Hi Dave, Shane and all

I have a case I could really do with some help with.

Left Shoulder Issue
  • 24 year old male rugby player
  • 2 years ago he got a supraspinatous injury in Aug 2019. Did a bit of physio, but not a lot and kept playing
  • Feb / march 2020 during a game, made a tackle and got a big stinger in left arm. Still had grip
  • 1 week later, lower arm felt fine, but upper arm still numb with poor ROM
  • Went to A & E and got an x-ray which was inconclusive
  • Went to see a shoulder surgen who did nerve conduction studies. Results showed that the was serve nerve damage to the auxillary nerve. It wasnt ruptured and he said things should return to normal.
  • Now has server atrophy to the medial and anterior deltoid (see picture). Posterior did show atrophy but has returned mostly now.
  • ROM is now back to almost normal. He trains and gyms fine, but shoulder is and feels unstable. Wont do full contact
  • Has lack of strength in most directions and whilst arms are at 90 degress and above head.

What can I do to start stimulating the auxillary nerve more, and to start to build the deltoids back up. Exercises so far have not had any effect. Tricep is overdeveloped probably due to compensation.

Are you able to set me on the right path? I'm seeing him again on Thursday, and it would be good to get him started.

Many thanks,

Charlie

IMG_7495.jpegIMG_7496.jpeg
 

Luke Gibbons

Mentorship Member
Joined
Feb 27, 2021
Messages
15
Hiya Charlie,

Sorry to hear about your patient, that's quite the amount of atrophy over the the deltoid.

I know the lads would have a far better insight into this but given the amount of atrophy and specifically anterior and medial atrophy of the deltoid, would be worth doing some simple anterior and lateral direction band work and build this into weighted variations.

I say this as the lifting action of the band work may more specifically target the anterior and medial aspects, as it forces these areas to be under load and it looks like you want decrease the amount of exercises, targeting the triceps, due to the stated overcompensation.

This may also address the perceived threat and confidence levels you mentioned of doing tests/movement above 90 degrees

Obviously we want to get him back to functional (push up position, walkouts etc) and rugby specific exercise as quick as possible but clearly this atrophy situation needs to be addressed and apologies if you have tried the above strategies already.

The axillary nerve also innervate terres minor and possibly some of the posterior deltoid but this atrophy appears to be improving in this area so possibly not as much of a need to go after external rotation,

Just one question, what are his shoulder outputs tests like and which ones are specifically decreased?

Thanks,


Luke
 

Bodymattersuk

Mentorship Member
Joined
Nov 23, 2020
Messages
6
Hiya Charlie,

Sorry to hear about your patient, that's quite the amount of atrophy over the the deltoid.

I know the lads would have a far better insight into this but given the amount of atrophy and specifically anterior and medial atrophy of the deltoid, would be worth doing some simple anterior and lateral direction band work and build this into weighted variations.

I say this as the lifting action of the band work may more specifically target the anterior and medial aspects, as it forces these areas to be under load and it looks like you want decrease the amount of exercises, targeting the triceps, due to the stated overcompensation.

This may also address the perceived threat and confidence levels you mentioned of doing tests/movement above 90 degrees

Obviously we want to get him back to functional (push up position, walkouts etc) and rugby specific exercise as quick as possible but clearly this atrophy situation needs to be addressed and apologies if you have tried the above strategies already.

The axillary nerve also innervate terres minor and possibly some of the posterior deltoid but this atrophy appears to be improving in this area so possibly not as much of a need to go after external rotation,

Just one question, what are his shoulder outputs tests like and which ones are specifically decreased?

Thanks,


Luke
Hi Luke,

Thank you for your reply. Yes Ive taken him right back to basics, with a lot of ST work through the posterior shoulder and tricep. Hi MO were poor in all directions except posteriorly .

Kind regards,

Charlie
 
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