Case Study: Neck and Scapular Pain with Disc Bulges

Our Patient

Our patient presented with persistent neck and interscapular pain lasting more than five years, with a history of overhead sports and a prior car accident. The patient had been unsuccessfully treated elsewhere.

The Challenge

Pain had begun prior to the patient’s car accident. The patient had received a brachial plexus hydrodissection, which failed to alleviate pain. An apparent misunderstanding of the underlying issue led to suboptimal treatment outcomes. During our assessment, the patient exhibited sporadic and involuntary scapular twitching, making for a complex diagnosis. Previous treatments had exacerbated the condition.

Our Diagnosis

We conducted a thorough examination to identify physical abnormalities, muscle imbalances, nerve entrapments, and structural irregularities. MRI indicated small disc bulges in the C4-C6 region, with mild degenerative facet arthropathy. We concluded that the patient was experiencing bilateral scalene syndrome, dorsal scapular nerve entrapments, periscapular fascial distortion, and other musculoskeletal issues.

Our Treatment Approach

To alleviate pain, we used focused shockwave therapy to address specific muscle attachments. DNS therapy was used for scapular stabilization, and hydrodissection was performed to target nerve entrapments.

Our Results

Following our treatment plan, the patient experienced significant pain relief, and the involuntary scapular twitching decreased. The patient’s overall function substantially improved.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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