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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.

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By Debbie Roberts, LMT

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Long Thoracic Nerve Injuries in Sports (Part 2)

Editor's Note: Part one of this article, in last month's issue, ended with the "In- Gravity Functional Movement" screening test. Here, Debbie resumes with the "Table Functional Movement" screen and gets resolution in the case findings.

Table Functional Movement Screen

Latissimus test was positive for both the lat and the glenohumeral joint being dysfunctional. The serratus test produced weakness and pain. There was a very slow hesitation and uneasiness moving her glenohumeral joint into external rotation.

Long Thoracic Nerve Injuries in Sports (Part 2) - Copyright – Stock Photo / Register Mark This did not produce pain in the shoulder, however once again it produced pain along the lower medial border of the scapula. I asked if she had fallen and she said she was clumsy, which can be an indicator to look for leg length discrepancies.

Her mother concurred that she constantly tripped over her own feet. She appeared to have a gross difference at the medial malleolus with a long left leg as compared to the right. Her femur on the left appeared longer but nothing could be concluded without a standing radiography.

The really important message here is what a screening and an assessment test can tell us with regards to helping the client achieve optimal movement again. After identifying problems within certain movement patterns, and, after identifying the problems, we can focus on the weakest link.

Finding the Weak Link

Here are four things to consider when finding the weakest link.

One: Long Thoracic Nerve

You will want to rule out the long thoracic nerve. The MM test revealed weakness of the serratus anterior; paired with her practice of an overhead sport and her cervical spine rotated to the left, I suggested she be seen by a higher medical professional. The objective here is to rule out damage or entrapment of the long thoracic nerve, which supplies the serratus anterior muscle.

The nerve typically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves and sometimes C8.  The roots from C5 and C6 go through the scalenus medius, while the C7 root passes in front of the muscle. As the nerve descends through the cervicoaxillary canal behind (posterior to) the brachial plexus and the axillary artery and vein, resting on the outer surface of the serratus anterior, I advised she would need both chiropractic care and myofascial work.

Two: Leg Length Discrepancy

Rule out leg length discrepancy. It's essential to deermine if this is anatomical or functional. If she continues to play on a true leg length difference then she has a very high chance of incurring multiple lower body injuries because of the misalignment. In this case a higher medical professional could decide if she needs a standing radiography test. If this is anatomical she may need a shoe lift. If this is functional both chiropractic adjustments and the myofascial work would be beneficial.

Three: Scoliosis

Rule out scoliosis. The same reason as above with regard to future unpredicted upper and lower extremity injuries. Also,  it's important to know if this is functional or anatomical. A higher medical professional would be able to look for a left over injury that is causing the spine to become stiff, that now has a rotational pattern. If it is functional then the myofascial work will be beneficial.

Four: Labrial Tear

Rule out labrial tear. She didn't stop playing after the MRI; she played through tendonitis and bursitis; all the muscles around the shoulder tested weak; and there was major hesitation of motion and end feel while performing external rotation of the shoulder. Due to this, surgical repair may be needed.

Case findings

The bodywork did resolve some of the pain symptoms, but not much was resolved in the loss of forward flexion. I referred her out to a local chiropractor with a report of my findings. He called me and concurred on the results of the screening and let me know of his plans to see her for next four weeks. He also asked me to continue myofascial massage. Remember the ultimate goal is to help a client not have any future problems, as well as resolving the current situation. Especially in this case since the client was only 11 years old.

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