Clinical features: A 51-year-old female with a 4-month history of right-sided shoulder pain with numbness and tingling in the right upper extremity presented with an established diagnosis of cervical disc herniation by company physician. Non-response to physical therapy, epidural injections, and work modifications led to a chiropractic referral to evaluate and treat. Symptoms were reproduced with 90° sustained abduction with external rotation and compression of the pectoralis minor tendon. Superior fixation of the right first thoracic rib, along with rounded shoulder posture, was noted. Cervical compression tests were negative and pain was decreased with right lateral flexion.
Intervention and Outcome: A combination of chiropractic manipulation to the first rib, post-isometric relaxation of the pectoralis minor, and corrective postural exercises for the rounded shoulder were performed for 10 weeks. Outcome was measured through subjective pain diagrams using the visual analog scale, response to orthopedic testing, and visual improvement of shoulder position in relation to the opposing shoulder. This type of management resulted in complete resolution of symptoms, improved rounded shoulder posture and produced negative orthopedic testing.
Conclusion: This case report discusses a conservative approach to the diagnosis, treatment, and management of pectoralis minor entrapment.
Key Words: pectoralis minor, entrapment, chiropractic, neurovascular, post-isometric relaxation, manipulation, posture, compression, cervical, disc, herniation .
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