03/06/2026
Case Study Follow up:
Patient returned for 2nd visit, with reported less burning into ribs and better OH mobility. Still with some scapular pain, but also improved. First provided picture also shows his scapular position after one visit
The muscle at fault for most of his pain was the serratus anterior, along with some subscapularis involvement. The serratus anterior is the main protractor of the scapula, along with helping stabilization against the ribs. It also helps with upward rotation of the scapula when overhead. Remember that our patient worked 60+ hrs OH painting and helped transfer/care for his father at home. We tend to see acute scapular winging when the serratus anterior is overworked, causing the surrounding muscle to guard and tighten
Pictures 2 and 3 show cupping around the scapular border for circulation, and dry needling to the subscapularis muscle, lat, pec, and around involved nerves. Not pictured are other modalities for soft tissue release and to decrease inflammation.
Patient was give specific exercises to correct his scapular winging and foam rolling to open his mid back, allowing his shoulders to relax. Picture 4 shows his posture and scapula before visit 3. Nearly back to normal and with much better symmetry and no reported pain
Taking a good history and really listening to a patient will give you 80% of the answer. The other 20% is good old fashioned hard work.
