Recently, I treated a patient with fairly common complaints of subacromial, anterior shoulder, and intrascapular pain. Upon evaluation, it was determined that trigger points in the infraspinatus, teres minor, and subscapularis muscles were contributing to the patient’s pain complaints and dysfunctional motor activation patterns.
After two treatment sessions, which included dry needling of trigger points in these muscles, neuro re-education, scapular stabilization, and postural/workplace ergonomics education, this patient reported approximately 80% reduction in pain complaints.
Then came the interesting part:
Patient: “Do you think you cured my rash?”
Me: “Wait. What rash? You didn’t tell me about a rash.”
The patient then explained that she had recently been evaluated by a dermatologist for an ongoing, intense itch over her scapula. She stated the dermatologist noted no rash and could not find a cause, but he gave her a cream for the itching, which she states did not seem to help.
Patient: “I didn’t think to tell you about this, because you are a physical therapist.”
Me: “Right….”
Patient: “Anyways, my itch is gone now. Do you think what we did somehow fixed that?….”
Me: “Yes. It’s possible.”
Referred sensation is a clinical presentation of muscle trigger points, and the referred pattern need not be pain. It can be sensations such as warmth, cold, numbness, tingling, pressure, running water, burning, heaviness, and ….. itching.
The patient’s reported area of itching lay within the subscapularis referral pattern.
Following two more sessions, the patient was discharged with resolution of the original shoulder pain complaints. The itch had not returned prior to discharge.