Long Thoracic Nerve Palsy: Anatomy, Assessment & Recovery
In this episode of the Unreal Results podcast, I share the case of a Navy SEAL candidate with severe scapular winging and progressive serratus anterior paralysis after months of failed treatment. I walk through the anatomy of the long thoracic nerve and serratus anterior in detail, including the entrapment sites, fascial relationships, and neural connections that can completely change how you assess and treat these cases. I also share how integrating neural manipulation, visceral treatment, mobility work, and targeted strengthening helped this athlete regain function far faster than expected.
In This Episode, You’ll Learn:
The most common entrapment locations for the long thoracic nerve and why they matter clinically
How cervical compression, thoracic outlet mechanics, and breathing patterns may contribute to scapular winging
Why upward rotation mobility is just as important as strengthening in serratus anterior rehab
Practical strategies for restoring upward rotation strength, scapular control, and thoracic mobility
This case is a great example of why treating the body as a whole organism instead of isolating a single muscle or diagnosis can completely change clinical outcomes.
Resources & Links Mentioned In This Episode:
Ep. 99: Navigating The Complex Case Of Diaphragm Paralysis
My Online Course I Mentioned - The Nerve Workshop with Missy Bunch and Anna Hartman
My Online Shoulder Course - Never Treat The Shoulder First
Learn the LTAP® In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in
Hello, hello, and welcome back to another episode of the Unreal Results podcast. I am coming in hot with another episode and, um, I- it's another sort of like the last episode, a little bit of a, like, a case to set up a conversation on the anatomy. And, um As I... Well, first of all, as I've been dealing with this case, it's been very fun.
Um, one, because it's an upper extremity thing, which it's been a while since I had upper extremity, um, athletes consistently. And, um, two, it's one of those, like, "Nobody can figure it out. Please help me. You're my last hope," sort of patients. Um, which is always fun. High pressure, too. I like, I like high pressure.
Um- But then, too, it's just been really interesting for me, like, learning about it and, like, diving in the anatomy. And, um, also it's been fun because from the jump, like, from the first visit with me, he has been making progress. And so that also makes it really fun, too, when you get to see results, like, so fast, so quickly.
Um, so anyways, I, I've been wanting to share it, and I've been kind of waiting to share it until, like, we get... I don't wanna be, like, in the clear, but, like, we get-- we had more evidence. Whoo. Excuse me. I wanted to share it. I wanted to wait until we had, like, more evidence that we were, like, fully on the mend.
So, um, yeah. So I had one of my Navy guys came to me with, um... I'm trying to think how many months he was into it. It had to have been
like four to six months already in it, and he was having severe winging scapula, basically serratus anterior, um, paralysis from long... Well, what the, what we think, I mean, uh, of course, uh, long thoracic nerve palsy. Um, and the long thoracic nerve palsy, it was, it's a little bit up in the air of, like, what happened, because he has a lot of factors that it could be, and the doctors who are working with him, I don't think...
You know, I'm not a doctor, so, I mean, this is just my opinion, I guess. Um, I don't think they probably did quite as good of a workup on him as they should have to diagnose it versus sort of just giving him this diagnosis right out of the gate. So basically, um, they, I think at first sort of treated it like a long thoracic nerve compression issue from crutches.
And because he had been on crutches because he had, um, fractured his fibula. So he'd been on crutches, um, been crutching around, and he will admit it, admit that he leaned on the crutches a lot. He was not using the crutches very mindfully. He was carrying heavy backpacks a lot while he was crutching. He was still doing a lot of upper body lifting, um, while he was rehabbing his leg injury.
Um, and so there was kind of a lot of factors, but I think at first they were thinking it was a compression injury due to the crutches. Um, and then it started to not really respond well after he got off the crutches, and he continued to have progressive weakness, um, and severe winging of the scapula. So then they referred him to a neurologist, and the neurologist saw him and they did not do any MRI.
They did not do any sort of exam to his neck. They did not do myotome testing, dermatome testing. They went straight to an EMG test. But they were actually unable, reading his EMG test, all of the other nerves tested one hundred percent. Um, and they were not actually able to test the long thoracic nerve.
The doctor didn't feel like he could access it properly, and so they didn't even assess the EMG activity of the long thoracic nerve. Um, but then they decided to label him with a diagnosis of, um, Parsonage-Turner syndrome, and they basically told the patient like, "Oh, this is like a viral neuritis, and it will spontaneously resolve soon.
And if it doesn't soon, within the next few months, then you're probably looking at like two years minimum, and you might be dropped from the program." Which is, I mean, that, that would be terrible. And so he came to me, um- at the pushing of some of his friends who had already been seeing me for rehab and were like, you know, like, "Anna, Anna will be able to figure it out."
And so I'm, first of all, I was like, when it, when, when he first told me that the doctor said it was viral, I was like, "What?" Like, I was like, "Were you sick?" And he was like, "No." And I was like, "That doesn't make sense." This is before I read his note from the neurologist saying it was Parsonage-Turner syndrome.
And it was interesting because once I read that, I was like, "Oh, okay. He thinks this is Parsonage-Turner syndrome." And I remember looking this up once upon a time because one of the alumni from the LTAP level one course had asked about it in our private Facebook group. And so I'd actually never heard it, heard of it before.
I've never had a patient with it before. And, um, so then I was like, "Okay, let me do some reading." So I'm gonna assume that you maybe are the same spot as me, and we're like, "I have no idea what that is." And so Parsonage-Turner syndrome is basically, um, idiopathic, uh, brachial neuritis. Um, it usually involves, um...
It usually has a trigger to it. Uh, the trigger most commonly is a virus. Um, it can also be, um A vaccination, it can be surgery, it can be pregnancy, it can be, um, strenuous exertion or trauma, um, and it, and it's thought to be like immune-mediated, but an immune-mediated neuritis that causes progressive paralysis of the muscles.
I think commonly, most commonly it is the long thoracic nerve, but it can affect other nerves and other muscles in the upper extremity, and it also can affect the phrenic nerve. And so I'm gonna have Joe link in the show notes episode I did on the diaphragm paralysis because I, I think there, there is like a little bit of similarities to this case and that case I presented because that was sort of the reasoning that, um, the doctor gave that patient too for the diaphragm paralysis at first was a viral thing.
And it made a little sense at the time because, um, I kept on from a LTAP and general listening standpoint, I kept on that patient coming to lung and liver, um, as the like thing the body was protecting, which definitely has a viral component to it, an immune-mediated component to it. But for this patient specifically, I wasn't coming up with that, and he symptom-wise didn't have it, whereas the other patient actually had a history of some significant illnesses and especially an illness or traveling abroad that we didn't really know what the illness was.
So this athlete, the, the trigger for him seemed to be strenuous exertion, um, exercise-wise because he does tell me-- he did tell me that the day... Oh, so before I tell you what his trigger was, I mean, I've described what his trigger wa-was, more a little bit about Parsonage-Turner syndrome. It usually is sudden onset of severe pain, progressive paralysis.
Um, the pain can last hours to days, um, maybe even weeks it said. Um, typically the, the whole experience is either anywhere between six months to three years, but has good prognosis for full recovery. But if it doesn't, they usually, um, can sometimes do, um, surgery for like nerve transfers. Um, it is pretty rare.
It only is reported in three, three people in every 100,000 per year. Um, and it affects men m-more commonly than women, um, and specifically men at usually around the age of 41 or above. So, um- So okay, back to my patient. He had, um, he had crutched over to do a workout, and his workout consisted of a ton of shoulder exercises.
He was doing pull-ups, dips, push-ups, um Pull-ups, dips, push-ups. I think that was mainly it, but, like, a lot of sets and reps, like an excessive amount. And then after that workout, he, um, also He might've been doing like overhead pressing stuff too, but either, either way, he was doing a ton of exercises. And, um, then also that night, um, he got treatment on the pulsed PMF mat, um, so at the neck and shoulder area.
Um, and he said that the duration of the treatment, which was minimum of 30 minutes, it might've been longer than that, he said the whole time his head was going into like violent, intense cervical retraction. And after that, he woke up in the middle of the night with severe pain in his shoulder and neck.
And then I'm not really sure how many days after he noticed the paralysis, um, if it was immediate or progressive, but that was sort of the onset of everything. And so I will say that I, I will say that though I feel like they could have done a more thorough workup on him Um, he does fit the, the clinical picture of Parsonage-Turner syndrome in that sense of if they're considering a trigger severe, or not severe, um, intense physical exertion.
Um What was surprising to me was given the intense physical exertion and the specific, um, cervical retraction motion he was talking about, and even if you watch him move, he's the type of guy that when he does shoulder stuff, he was a big, like, lower cervical, um, extension, mm, movement dysfunction type of person.
Um, and then if you take into consideration what he does for a job, even though he didn't do that within this time period, leading up to that, he did a lot of it, which is these n- these Navy SEAL candidates, they carry the, the boat on their head. And there's usually six guys in a boat, sometimes seven, but each position in the boat is numbered, and the number two position tends to take, um, a huge percentage of the weight of the boat on their head.
And so that's the axial compression. Um, it's the two position. And this person, this patient of mine, he was known for, in his boat team, as the guy who would always take the two position, like, the whole time, which is, like, admirable. Everybody loves the guy that does that because the two posit- position sucks.
Like, but it's, like, not so good on his neck, right? So, and these boats weigh, like, s- an ungodly amount of weight. Like, I wanna say, like... I wanna say 800 pounds, but I feel like maybe that's wrong, so I'm gonna Google it real quick. I'm pausing. All right, I'm pausing. No, no surprise, I embellished it. In my head, I don't know why I was thinking 800 pounds, but I also knew that that sounds, sounded like too much.
Um, it typically weighs, empty, it typically weighs between 250 and 300 pounds. Um, oh, okay, it says, "During grueling evolutions like Hell Week, though" ... Okay, I didn't make it up. "These boats often fill with water and sand, bringing the effective weight upwards to 400 to 800 pounds or more as a team of six to seven car- candidates carry it over their heads."
Okay, well, I'm not lying then. Okay, so like I said, he takes the position in the boat where the majority of the weight is on his head versus the other team members. And so, um, in my clinical brain, I'm like, "Oh, you have a lot of cervical things that could lead to a little bit of a compression of these nerve roots too."
And I'm like, "Why did no one do a cervical MRI on you to kind of rule that out?" Um, and so that was always interesting to me. And w- I'll circle back on that when I, when I share about, like, how this case has progressed. Um, but I think it's-- I think right here, before talking to you about the whole case and how I've been treating it and how he's doing, um, like, let's talk about the anatomy here, because I think, I-- like I said, I don't think it's wrong.
Like, I think it's fine to label this as Parsonage-Turner, especially at this point, because it's like, okay, you're improving, so why not? Um, but I think initially it would've been cool to get some other diagnostic tests done so you were, like, 100% sure it was Parsonage-Turner Syndrome instead of something else.
So, um, and then this goes to, like, again, whenever we're dealing with anything, um, function-wise coming off of the brachial plexus, we need to consider, like, all the possible spots that there can be an entrapment or a traction injury to the nerves or the arteries. And, and why the arteries matter, too, is because the arteries supply the nerves with blood, like blood flow, and the nerve won't function without good blood flow to it.
And so they, they work hand in hand. But an injury can affect either/or, and both of them. Um, so to me Again, when you look at his work history, when you look at the initial injury or initial history around the initial onset of his injury, I'm like, ooh, I kind of feel like cervical quite a bit. So, um, so let's talk about it.
Long thoracic nerve comes from three nerve roots, C5, C6, C7. So, um, C5 nerve root also is influenced by the phrenic nerve and the relationship between the viscera and the phrenic nerve. And so I do think that is relevant. I don't think, um I do think that's relevant to keep in mind because this talk-- this also, like, leads us to consider different visceral things in the thorax, in the abdomen that could be contributing to these altered signals at the C5 nerve root.
All right. So then, um, the-- those three nerve roots, the two, C5 and C6, join together earlier on supraclavicularly, above the clavicle, and they innervate the serratus anterior, um, on the superior section of it, which I... Looking through this, I have found some mind-blowing pictures of the serratus anterior, which I've never really considered before, and there is a superior portion of the serratus anterior that comes off of that medial border in the superior angle of the cla- of the scapula and comes around and attaches to the first and second rib.
Like, what? I had no idea it attached to the first and second rib. I knew it attached to the ribs, but I, for some reason, thought it was lower down than that. I mean, the bulk of the serratus anterior is more inferior, but I was like, "Wow, there is a very significant superior attachment." And the branches from C5 and C6, um, of what it will become the long thoracic nerve, innervate the serratus anterior here.
And in this supraclavicular area is the first spot, um, really that there can be a-- or a second spot, actually, there can be a nerve root compression. So the first spot is the nerve root itself at the cervical spine, and the nerve root itself, the neural foramen, um, from the spine. So compression spot number one.
Compression spot number two is the C5 and 6 nerve roots go through the middle scalene, um, as they come down in the anterior position to innervate that superior portion of the serratus anterior, um, in that, like, upper thoracic area above the thoracic inlet. And then the, um, C7 portion of that runs parallel to the suprascapular nerve and also can be entrapped in that sort of superficial fascia of the, um rib cage and shoulder.
Um, it can be entrapped, um Under-- and then, right? So there's a s-second spot. Third spot is all three of those branches then proceed underneath the clavicle, um, to along the rib cage at midaxillary line, and then they go down along the midaxillary line. So the next spot, retroclavicular space, and then clavicular pectoral fascia, so behind the, um, pec minor on the thorax.
Um, it invests along, um, the thoracic wall here, so h- like, it can get entrapped in that fascia throughout that whole way. So main entrapment spots: cervical spine, scalenes, um, like thoracic inlet fascia, retroclavicular space, clavicular pectoral fascia is five, um, and then in the thoracic fascia superficially for the long piece of the, um, long thoracic nerve, which now all three nerve roots have come together, um, and underneath the clavicle once it hits that midaxillary line and becomes what we, like, really envision the long thoracic nerve of as it comes and, um, gives branches off at each interdigitation of the serratus anterior, the middle or intermediate in the inferior edges, um, along with intercostal nerves here.
Um, the serratus anterior interdigitates with the inter- the external intercostals as well, so they can sort of have a relationship with each other as accessory breathing muscles. And, um The nerve branches, um, from the main branch of the long thoracic nerve here, all of these are very superficial. Not a whole lot of s- stuff between the skin and these nerves.
This is why it's so common to have a crush injury there from our, um, from, from crutches. Um, but the-- each sort of branch is like a r- 90-degree right angle as it innervates that area. This is also an area where the subscapular artery can be c- um, compressed or entrapped and affect the distal part of the long thoracic nerve too and cause a scapular winging.
It's even more rare. It's, it's pretty rare, but, um, you can definitely appreciate in someone... It's like, I wish I could show you a picture of this athlete. He's very hypertrophied. He loves to lift. Um, and so I'm like, "Hmm, it is very possible on him that an, an entrapment between the subscapular muscle and the rib cage, that bursa, the, the, the fascia in that area and the radial nerve could entrap the s- subscapular artery and cause a little bit of ischemic compression causing a decreased, um, nerve activity."
So that's-- I don't think that's what was going on with him, but it is within reason that it could have been something, um, for sure And also to, especially when we start to like match how he's responded to treatment, which I'll, I'll continue to, um, talk about. But, um I'm checking my notes here of things I've missed Um, there, in terms of the serratus anterior, there is a relationship with the, um, nerve to the levator scapula, um, and the superior portion of the serratus anterior via the dorsal scapular nerve and the suprascapular nerve.
Maybe some branches seem to anastomose in that area, um, as well as to the accessory nerve, the spinal accessory nerve in that area Um, it invests, like I said, with the intercostal fascia, um, and the intercostal nerves. Oh, and then here again, like, um, another reading some anatomy of the long thoracic nerve is basically like heavy load on the neck, mid-scalene, causing middle scalene or post-mid, uh, posterior scalene compression entrapment at that scalene area.
Very, very much a thing. Also, that is the area that you would get a traction injury due, due to a heavy backpack, um, or in women, like a heavy bra strap. Um, so definitely a lot of things when you look at the anatomy of both the long thoracic nerve and the serratus anterior in common entrapment areas of not just the long thoracic nerve, but branches that anastomose to it and this, um, sc- subscapular artery that provides blood flow to it.
It's like, oh, now we start to see a clinical picture that is like, there's a lot more that it could be than Parsonage-Turner syndrome. Now, um From the get-go, so that's an anatomy. From the get-go, this case has been kind of crazy. Like the amount of winging he had, like especially noticeable when he put his arm out at 90 degrees of flexion, it was like significant winging.
Single arm pushup on the wall, significant winging, um, and weakness. I tested his serratus anterior strength in sideline so I could take gravity out of it to a bit. And that was day one and I was like, I was encouraged because I actually was able to f- like feel like there was something there. It wasn't a zero out of five.
It was like maybe a two out of five. Um, and, um, the other cool thing is with my neural manipulation skills, I was able to palpate the distal part of the long thoracic nerve and I felt nerve activity there. And it's like I know that's crazy to hear for those of you who maybe don't know how to have such sensitive feelings in your hand, but it was like very much so in the area of the long thoracic nerve which is midaxillary line all the way down to rib nine.
I felt rib a- I mean nerve activity and it's like I guess you could argue maybe it was intercostals but it was again in this very vertical position that was much like the long thoracic nerve. So from a treatment standpoint just like I do with everyone right he comes in and I assess him and I assess him two ways.
I assess him with the LTAP to see where the body is directing us and then I also assess him orthopedically and part of my orthopedic assessment was like ruling out like w- was also like do I believe the doctor? Do I really think this is a viral neuritis like Parsonage-Turner syndrome thing or could there be something else?
And so, um That's also why it's like, okay, I'm gonna as- assess all these entrapment areas. And, and the first day of the LTAP it took me to his cranium and his cervical spine, so I treated that and it improved his, his function quite a bit. And then I went into... And then there... I went into treating just the long thoracic nerve, treating the entrapment areas.
And the, the gains we made in the first day he was like, "Holy cow." He's like, "That's crazy." And I was like, "That actually it is crazy, but, like, l- let's go. Like, I'm for this. I'm, I'm so excited for you here." And then, um, the second time I treated him the body directed me to his lungs. So very interesting to, you know, when I also reading the anatomy about how the serratus anterior interdigitates with the intercostal fascia, because the intercostal fascia, um, you know, on the, on the interior side of it is connecting with the pleura and it was his, the superior, um, lobe of his lung that, um, needed treatment.
And when I treated that he also made some significant gains. But again, there's a phrenic nerve connection there too. The phrenic nerve innervates that viscera, so that feeds back into C5. Um, I tested his myotomes and his myotomes at C6 and C7 were weak. That's why I was... That was a little bit where I'm like, "Why didn't the neurologist check this?
You have weakness in your myotomes." The neurologist did test his reflexes and his reflexes were good but he had weakness in his myotomes. I checked his dermatomes and he did not have any dermatome, um, numbness or altered sensations which is nice. So I was like, "Okay, you've got some nerve root components of this, so let's do some nerve glides."
And I basically went to me and Missy Bunch's workshop, the nerve workshop that we did. And I went through all of the nerve glides of the nerves that come out of the nerve roots of C5, C6, C7 and we also did the spinal accessory nerve. Now I did the spinal accessory nerve glide as a thing of like, well, I'm trying to improve your upward rotation function because serratus ant- anterior is such a big, like, component of upward rotation but so is the upper trap.
And so I'm like let's, let's see if doing that will help. But now reading this, um, journal article about the anatomy of the long thoracic nerve it looks like it might anastomose with the spinal accessory nerve so I'm like, oh, no wonder we had good results with that. But we also did radial nerve glide, musculosc- musculocutaneous nerve glide, um What were some of the other ones?
Those are the big ones. Accessory nerve, muscu- musculocutaneous nerve, and radial nerve glide all, um, gave us really good, um, results. Um, I think maybe even axillary nerve glide helped too in terms of improved his myotome function, but then also improved his upward rotation pattern strength, serratus anterior strength.
Um, we cupped in the area. We treated every possible entrapment site. We did, you know, clavicular pectoral fascia work. We did retroclavicular work, and then we've been strengthening it. And the hardest thing with him from a strengthening standpoint is that he's so strong he can cheat it really well. And so the strengthening has really been, how can I put him in positions that forces him to use the serratus anterior?
Because he's always going to choose the stronger muscles. And so we've done quite a bit of closed chain things. Um, my, you know, my favorite like crisscross, um- Cross leg and lift, um, was like one of the first things we started and it's been a favorite. We did a flexed cat, cat, like cat lift, knee lift. We did, um, the sideline, um, stuff.
Oh, and all this stuff too, his downward rotators were so stiff because he does so much exercises for, um, pulling. And so as much as we've done strengthening, we've also really emphasized mobility into upward rotation. So it was easier for the muscles to work because I'm like, you're setting yourself up for making this harder than it needs to be by having such stiff downward rotators.
So we've really matched, we've paired a ton of upward rotation mobility with upward rotation strengthening, um, which has been really helpful for him too. And, um, the gain, he's made gains every session and it's been really cool to see his strength come back. I mean, it's like, I, it's, I, I've been sharing it in my mentorship group, like this case and showing videos of him and stuff.
And I literally feel like I have a little kid because I'm like, if, if I'm around anybody that knows anything about rehab, I'm like, ooh, can I show you my patient? Because like he had this paralysis of his lung thoracic nerve and like within, I mean, within the first session, but like every session we've been making huge gains and we've done nine sessions now and he's gone from...
So one of the measurements I do is how far away from midaxillary line is the inferior angle of the scapula in active shoulder flexion and abduction. He started day one being eight inches, eight inches away. That's how little upward rotation he had, eight inches away from midaxillary line. You're supposed to...
The inferior angle of the scapula is supposed to have reached midaxillary line, full range of motion. So that's why I use it as a measurement. I'd say most of the people when I assess them with, like, regular strength, you know, could be better, but I, I consider, like, good enough at two inches from midaxillary line.
And now he is at less than three inches, and I'm, like, so stoked for him. He's made such great gains, and he's feeling it, I'm seeing it. He's doing all sorts of pushing stuff, and he can even, he can even have his arm out at 90 degrees without instantly winging. So he is finally at that strength point of three out of five, right?
Because three is, like, against gravity. In side line, he's more than three. Um, he's probably, like, three, three plus now. Maybe, maybe if I tested it fresh out of the gate it'd be a four. So it's been a really fun, um, treatment of, like, treating all the things. We're treating his cervical spine. Well, and that's a big thing, too.
We're treating his core control. We've really done a lot of including connections from his external obliques into his serratus anterior, this cross-body sling system, to reinforce the function. Because again, the serratus anterior interdigitates not only with the intercostals, but with the external obliques.
And so I'm using those relationships to help assist us with serratus anterior strength and function. And with that, too, we're improving his core control. We're improving his head and neck control, too, which I, I love because, again, I don't not think that he has some sort of cervical compression that could have been adding to this, right?
Like, we can still... Like I said, we can still call it Parsonage-Turner syndrome, and maybe it was, but, like, we can't ignore all of these levels of entrapment potential he had as well. And so w- that's how I'm treating it, is first follow body, treat where it takes me, and it has taken me to s- a couple of th- the entrapment areas, as well as a couple of the areas that reflexively are going to relate a lot to the fascial containers of the thorax, of the neck, of the shoulder.
Um, and so, you know, I feel like we're just cleaning everything up on him, and we're just... He, he's doing great. He's on leave right now at home visiting his family, and he just texted me today and he was like, "Anna, my shoulder's doing great. Like, I'm doing great." And I'm just super pumped for him because Like, he's gonna be able to, like, class up hopefully and, um, and, and restart his process through BUD/S and, you know, fingers crossed that the cervical, the axial load of the boat doesn't, like, hurt things.
But I've already even had a conversation with him on that about like, "Hey You're not gonna be perfect by the time you get back, you know? Like, as strong as we would like you to do- be because of our timeline, but let's be smart and not be the guy that takes the two position all the time. Like, because that axial load can put us in a scenario that it triggers this compression and, um, long thoracic nerve issue again.
So, um, yeah, it's been great. I'd say that, like ... I mean, again, each visit we made progress. Like, even visit one we went from eight inches from mid-axillary line to six, and then visit two we started at seven and we went to five, and then it was, like, started at six, went to four, and, like, every, every time he has, he has, um, progressed.
And I'd say, I'd say it was probably visit seven, six or seven, that I was like, "Wow, you are, like, good." Like, you're to the point where I- I'm like, which, which arm is it? Like, he's to the point where I'm like, this is, like, just regular amount of winging for, like, a regular amount of weakness of somebody who doesn't use their upper rotators very well.
It does not look pathological anymore. And that was s- just so cool to see, and especially, too, like, you know, the P- PTs at BUD/S had kind of g- given up to- on him. The other practitioners he was seeing in town were, like, just doing the same thing over and over again, kind of giving up on him. The doctor...
Everybody had kind of given up on him, and I was like, "We can, we can deal with this." And so it was really cool. It's been a really cool, um, case and a really cool To like really also like put all my tools together, the exercise pieces, the, um, fascial pieces, the neural manipulation, the visceral manipulation, the, um, you know.
Like, and it's been fun to like dive into the anatomy. Like again, learning things about the serratus anterior that I didn't know before, learning things about the thor- long thoracic nerve that I didn't know before. I didn't know it was like in multiple parts until subclavicular, right? Like, so it's like, this too is why I continue to stress with the practitioners that I teach that like you need to be studying anatomy every day.
Like, this is an example. I read like multiple articles on the anatomy of the long thoracic nerve today, the anatomy of the serratus anterior, and the amount of pictures that I viewed today too looking at it is like, man, these are such awesome pictures, and pictures I've never seen before that gave me angles of seeing it in the body that I've never looked at before that start to give you a picture of the 3D-ness of things.
And the better you can have, um, an idea of the 3D-ness of the anatomy, the more it carries over to your actual practical application in your treatment sessions. So anyways, I hope this episode was helpful for you and has given you some insight on something like Parsonage-Turner Syndrome, but also like given you some insight on thoracic outlet syndrome, because at the end of the day, this is really what that is potentially.
It's thoracic outlet syndrome with perhaps a immune-mediated, um, neuritis as part of it, which is again, just like the diaphragm paralysis patient that I had as well. So it's like there are similarities in this, um, that I am forever learning deeper and deeper about the very intricate anatomy of the neck and thorax.
And, um, I hope you learned something from it too. So have a great week. See you next time.