Thoracic pain
History
A 39 year old female presents with a two week history of pain between her shoulder blades. The location of her pain is on her left middle back between her shoulder blades and left sided neck pain. She reported no mechanism of injury but conveyed that the pain commenced in her shoulder and then moved to her middle back and neck. No pins and needles or numbness was reported and her symptoms were aggravated by lifting up her arms and rotating. Mrs. X has a history of this complaint previously, which typically settles without intervention in a few days. Her past medical history included having her gallbladder removed (due to a benign tumour) 12 months ago with serious post-operative complications that required six additional surgeries. She also had a motor vehicle accident 2 years ago where, and she sustained a neck injury that was managed with physiotherapy. Mrs. X’s current goals of physiotherapy were to reduce muscle spasm and be able to perform activities of daily living without pain.
Clinical examination
On examination in sitting, the patient demonstrated reduced range of movement and pain in her cervical and thoracic spine, especially with rotation movements with her arms abducted. Cervical flexion, extension and left rotation were reduced and combined movements retraction and extension was reduced and painful. Cervical left rotation and extension provoked her scapular pain. When looking at her thoracic spine movements, left rotation was reduced and extension was reduced and painful. When examining passive accessory movements, her thoracic spine was stiff and painful with PA mobilisations and she was stiff with left unilateral PA mobilisations of her cervical spine.
Diagnosis: Cervical derangement
Management
Mrs. X’s treatment included patient education regarding posture and about cervical referred pain was explained to Mrs. X to help her understand the cause of her symptoms. Mrs. X’s symptoms originating from the cervical spine were reduced with left unilateral mobilisations as well as retraction and extension mobilisations with movement (MWM). This increased her rotation range and reduced her scapular pain with arm movements. In supine, left lateral flexion PPIVM’s, repeated left rotation and extension, and retraction and extension further reduced her pain and following this treatment only reported slight pain at end of her rotation range and no remaining muscle spasms with arm movements. Other techniques including thoracic spine mobilisations and soft tissue releases of her upper trapezius muscles were also performed to reduce her stiffness in her back as a result of muscle guarding and avoiding movement for the last couple of weeks. Mrs. X was additionally encouraged to complete cervical retraction and extension movements 10 times, 3-4x day until her next consultation to maintain her progress.
If you have any questions regarding thoracic or neck pain, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble