What is the diagnosis for a patient presenting with persistent left-sided tightness, scapular dyskinesia (abnormal movement of the shoulder blade), and uneven shoulder height, with the right shoulder being lower than the left, and no palpable anomalies?

From the Guidelines

I strongly recommend a comprehensive approach to address the patient's left-sided tightness and shoulder asymmetry, focusing on a combination of diagnostic imaging, physical therapy, and postural exercises to improve alignment, strength, and flexibility. The patient's symptoms, including constant left-sided tightness, the feeling that the left shoulder blade is out of position during pull-ups, and the visible asymmetry with the right shoulder sitting lower than the left, suggest potential muscular imbalances or mild structural issues 1. Given the complexity of shoulder pathology, as highlighted in the study on acute shoulder pain 1, a multimodal approach is necessary for accurate assessment and treatment. Key components of the treatment plan should include:

• Ordering a scoliosis 2-view X-ray to evaluate for any structural abnormalities, such as scoliosis or other spinal irregularities that could be contributing to the patient's symptoms.
• Referral to physical therapy with a focus on dorsal muscle strengthening and postural correction to address muscle imbalances.
• A daily home exercise program targeting postural muscles, including:
  • Scapular retractions
  • Wall angels
  • Thoracic mobility exercises These exercises should be performed 2-3 times daily with 10-15 repetitions each to help retrain proper alignment patterns and improve flexibility in the upper body. While the study on acute shoulder pain 1 emphasizes the importance of radiography in demonstrating shoulder pathology, it also underscores the need for a comprehensive approach, considering the wide variety of structures and pathologies involved in shoulder function. By combining diagnostic imaging, physical therapy, and postural exercises, we can effectively address the patient's symptoms, improve their quality of life, and reduce the risk of further complications or injuries.

From the Research

Patient Complaints and Symptoms

• The patient complains of tightness on his left side, which is constant.
• The patient reports feeling like his left shoulder blade is out of position when doing pull-ups.
• The patient's right shoulder is lower than the left when sitting or standing.
• Upon palpation, no anomalies were detected.

Diagnosis and Treatment

• A scoliosis 2V x-ray has been ordered to diagnose the patient's condition.
• Physical therapy has been recommended to help improve positioning and strengthen the dorsal muscles.
• Postural exercises have been suggested to enhance alignment and flexibility in the upper body.
• According to 2, physical therapy can significantly improve muscle strength, relieve pain, and improve spinal mobility and postural control in patients with scoliosis.
• As stated in 3, the treatment for idiopathic scoliosis is based on age, curve magnitude, and risk of progression, and includes observation, orthotic management, and surgical correction with fusion.

Scoliosis Overview

• Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae, as defined in 3.
• The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic, and spinal curvature due to secondary reasons, as mentioned in 3 and 4.
• Imaging modalities such as radiography, computed tomography (CT), and magnetic resonance (MR) imaging play pivotal roles in the diagnosis, monitoring, and management of scoliosis, as stated in 5.
• According to 6, medical imaging is essential in diagnosing and grading the severity of scoliosis, and treatments include anti-inflammatory drugs, body braces, and corrective surgical procedures.