Abstract

Introduction/ Background: Teres major muscle tears are rare injuries with <30 case-studies and 2 case-series in present literature. This case study contributes to the limited existing research and investigates conservative treatment as a validated treatment approach for rehabilitation. Furthermore, current rehabilitation for these injuries have only included Physical Therapy (PT); this is the first case study that incorporates the concomitant use of PT and OMT.

Case: 39-year-old male presented with two-month history of right shoulder weakness and bicep pain. Patient felt a “gum stretching out sensation” during a cross-fit KIP toe-to-bar pull-up exercise. He reported 2-3/10 axillary pain and local swelling. A soft tissue bulge (1.5in diameter) was noted on the inferior lateral right scapula. A wide field-of-view evaluation of the shoulder girdle MRI confirmed injury consistent with a grade 2 muscle tendon junction tear in teres major. A combination of OMT (MET, CS, LAS, transverse friction rub, FPR, HVLA) and PT was recommended to address soft tissue restrictions, altered muscle firing patterns, postural misalignment and weakness, respectively.

Results: After two OMM treatments, patient's bicep pain decreased from a 3/10 to a 0/10. Soft tissue bulge decreased by 0.5in. Increased strength was noted. During third OMM visit, patient noted pain remained a 0/10.

Discussion: This case study adds to the limited existing literature and contributes evidence that concomitant use of OMT and PT in teres major tears can show significant improvement without surgery. This was exemplified by the patient’s increase in strength and decrease in pain. One limitation to this study is that the treatment is still in progress. Furthermore, this case study shows how the joint treatment usage of OMT and PT can be applied to other musculoskeletal injuries.