The Triple Crown: A Regional Independence Approach to Managing Axillary Pain, A Case Report

Abstract

BACKGROUND: The regional interdependence model is an approach that can assist in better discerning complex symptom presentations and developing a specific plan of care. CASE PRESENTATION: A 33-year-old female equine stable worker presented with reports of chronic axillary pain limiting work participation. Objective testing revealed radiating axillary pain with thoracic and rib testing, scapular dyskinesis with shoulder girdle and kinetic chain strength deficits, and thoracic spine hypomobility. OUTCOME AND FOLLOW-UP: The patient returned to full-time work in 3 sessions with treatment focused on thoracic/rib mobilization and shoulder loading. Full recovery was facilitated through combined kinetic chain and functional shoulder loading. DISCUSSION: The principles of regional interdependence can play a role in effective and efficient diagnosis and treatment of many orthopaedic conditions. Considering regional interactions can be particularly important for both differential diagnosis and treatment of patients with orthopaedic pathologies where the pain generator is unclear, such as axillary pain. JOSPT Cases 2023;3(1):59–73. Epub: 4 November 2022. doi:10.2519/josptcases.2022.11295