Management of leavtor scapular region Pain

25/F has pain in levator scapular region on left side since 4months. She works in a food factory and has moderate to light tasks to be done for 8hours a day. Constant pain was 40% Onset- patient made theplas for 2 hours continuously after which she started getting constant pain for which she had pain killers for a week but to no relief. After a week, physiotherapy started Examination- Swelling seen on levator scapula region. Posture mildly protracted shoulders All shoulder n thoracic ranges were full. Cervical right wide flexion was minimally reduced with pain on left upper trapz region. Muscle strength- Levator scapula n upper trapz- tight Middle trapz lower trapz - weak All other girdle n shoulder muscles were weak as compared to her right side. Worked on those muscles and posture correction. Counselling for rests in between and reduced physical tasks. Intermittently physiotherapy was stopped by the patient and now her pain is reduced to 10% with heaviness in that region felt constantly. Her work profile has changed to computer work for 8 hours a day. Pain increases only when she does any physical work for more than 30mins. Pain subsides after she stops the work in another 30mins. Please advise further management of this patient and your views on it.

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Investigation X Ray Cervical spine AP Lateral . CBC ESR Vitamin B 12 Vitamin D 3 Cervical traction & physiotherapy suggested Regular exercise Weight lifting should be stopped Neck collar use Rest for 21 days

Have given her rest in between for 3 weeks but the moment she starts there is pain Thank you @Ved Prakash Singh
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Hi... Core muscle strength ? Cervical flexors are the first core muscles and in case that the individual has a tendency to use a forward head posture for tasks or the work table is not ergonomically designed, recurrent strain on the muscles is highly likely.. since it is not possible for person of such a young age to take rest or leave the job.. better to explain to the patient the importance of leading a healthy Lifestyle with strengthening exercises and also to make suitable changes to the workstation so that the joints can be well aligned during work...

Thank you doctor
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Tell her to take break after 25 min (before fatigue) and do active movement of it in 5 min then restart work for another 25 min cont in this way...advice her neck pillow even or proper neck and back supporters available in market...if she will be able to do her work proper way then half of problem is solved and than you can continue strengthening of weak muscle and stretching of tight but she needs more focus ergonomically first and if swelling is also there icepack is must.

Have advised ice pack before but to no relief. Have adviced activity pacing of rest and work but no major change in her pain Have given her neck pillow advice but low compliance on that. Thank you @Khyati Thakkar(Pt)
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There is a weakness of that particular mucscle and repeatedly overuse are the main reason .ask patient to go with strength training of that particular muscle like it should be with gravity like supported and than against gravity and than with weight .but first make sure the tear should not be at grade lll .as grade lll muscle damage need different treatment than this.

Thank you doctor
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Pl.get an MRI of the shoulder done to assess the extent of damage to the muscles and tendons and proceed accordingly.

Thank you doctor
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