In every issue of our journal you will find Case of the Month which we will select among submitted ones. Everyone who is using MEDICAL MASSAGE PROTOCOLs in their practice may submit their cases for the review and we will share with our readers the best one in every new issue.
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In Issue #1, 2013, JMS we published “Medical Massage VS Silent Killer” as our Case of the Month, which was sent to our Journal by Bojo Shestich, LMT, MMT. In this current issue, we are featuring a contribution by Curt Lezanic, LMT on a similar subject.
The anterior scalene muscle is a key to the upper extremity and the reason it has earned the nickname “Silent Killer.” Any abnormality on the upper extremity starting from the shoulder (Bojo’s case of Rotor Cuff) to the wrist (Curt’s case of De Quervain’s/Styloidits) can be caused by a mild irritation of the brachial plexus by the anterior scalene muscle with silent formation of the secondary symptoms down to the upper extremity. At this stage the client does not complain of any pain on the anterior neck, and this simple fact sends many health practitioners on the wrong path to treating it as a local pathology. Both cases clearly illustrated this fact.
The practitioner must examine the anterior scalene muscle in every patient with any abnormality on the upper extremity and if Wartenber’s Test and/or the Trigger Point Test are positive the first critical part of the treatment should target tension in the anterior scalene muscle.
MEDICAL MASSAGE vs STEROID INJECTIONS FOR THE TREATMENT OF STYLOIDITIS
Recently, a sixty-eight-year old female walked into my clinic located in the family practice office, presented her right wrist to me and asked, “Can you fix this?” Observing her wrist, I noted that her wrist looked exactly like the picture on page 431, of the Medical Massage Volume I textbook, which I constantly refer to. The patient had just presented me with my first case of De Quervain’s Disease/Radial Styloiditis.
For those who are not familiar with this abnormality, let me describe its pathology. If the patient’s hand is placed on its ulnar edge in the position half pronation/half supination the practitioner may see something resembles a soda straw under the skin at the base of the thumb where it meets the wrist. This is the inflamed tendon of the abductor pollicis longus muscle, which rubs against styloid process of radius. Almost any movement of the thumb, especially the thumb’s grip, causes pain. In this client’s case, the pain was very intense.
The patient had just left her doctor’s office, and in that meeting had requested an additional steroid injection in the wrist to alleviate the pain. Her physician told her that she had received the maximum number of shots, and that he would not refer her for any additional steroid injections. This is what brought her to my office.
I followed the examination protocol for De Quervain’s/Styloiditis. She tested positive in all recommended tests. As part of my evaluation of every patient with any complaint on the upper extremity, I examined her anterior scalene muscle by performing the Wartenberg’s Test. My goal was to determine if the cause of her wrist pain was original pathology or a symptom caused by the anterior scalene muscle. With almost no pressure applied above her right clavicle on the anterior scalene, the patient almost levitated with pain off my table. At this moment I realized that I just found the real cause of the pain in her wrist: the tensed anterior scalene muscle entrapped the brachial plexus and the radial nerve entrapment caused the inflammation of the tendon and styloid process of the radius.
I proceeded to follow the Anterior Scalene Muscle Protocol. After a couple of minutes, the patient interrupted me by saying, “Curt, my neck does not hurt.” I explained to her that the anterior scalene muscle was putting pressure on the nerves, and that this pressure was causing the pain in her wrist. Unfortunately, she is an “A-type” personality. A minute or so later, she again said more forcefully, “Curt my neck does not hurt.” I said, “I know but I feel this is the root cause of your pain,” and continued to work. Finally, in total frustration she said, “Curt my neck does not hurt … it’s never hurt … the pain is in my thumb!”
By this point, I had finished the Anterior Scalene Protocol including the trigger point. I directed her to move her wrist and thumb. In a rather loud voice she said, “Oh my God, it’s 80% better,” and then, in a really loud voice so everybody in the clinic could hear, she yelled out, “Why don’t all these @&$ doctors know this?”
I treated her five additional times. Each time her pain was less than the previous appointment, and by the fifth appointment, the pain in the wrist was completely gone. Now, the funny part of this story is … the patient is the doctor’s mother-in-law!
Curt Lezanic received both a Bachelor of Science and a Master of Science degrees in education from Kearney State College, now known as the University of Nebraska at Kearney. His teaching experience includes junior high and senior high teaching in public education and faculty positions in higher education. Administratively, he has worked as a department head, dean and campus director primarily at the community college level.
In the early 1990’s, Curt returned to the classroom as a student to pursue massage therapy. He worked for several years at a local resort/spa as a contract massage therapist and developed a local clientele. In 2009, Curt was approached by Dr. Scott Campbell. Dr. Campbell asked Curt to work with several of his patients who were experiencing various muscular/skeletal issues. Over the next several months, what had begun as a part time on call relationship with Dr. Campbell grew into what was becoming a full time commitment. In 2010, Curt retired from the college where he had worked for twenty two years and established his massage practice at the office of Dr. Scott Campbell in San Antonio, Texas.
Category: Case Studies