Anterior shoulder pain. A case

Can you figure out why this lady has anterior shoulder pain on the left side?

This patient presented with anterior shoulder pain near the deltoid on the left when performing a “downward dog“ type of yoga stretch. She also states she has decreased strength in these muscles.

On examination her shoulder had near full active and passive ranges of motion with some discomfort and restriction at the end point of forward flexion. Motor testing revealed all muscle strong and 5/5 with the exception of the serratus anterior. Can you see the winging of the scapula on the left?

The Serratus anterior is integral for helping position the glenoid with different shoulder motions ( including gait) and in this particular case, she has weakness. He is also involved with “background positioning“ via the basal ganglia and this patient is a Parkinson’s patient. Not that you are directly but are certainly indirectly related through their central connections.

Weakness can often be due to local injury or sometimes pathology effecting the long thoracic nerve at C5,6 and 7. She has moderate osteoarthritic changes in history of a fusion at this level.

Rehab for a start in addition to gentle mobilization included thoracic spine manipulation as well as scapular protraction/retraction exercises in both and against the wall as well as prone position

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