Hi Tobias,
> Current status and symptoms: Typically inflammatory symptoms with aggrevated
> pain in the mornings and after periods (>20-30min) of sitting still. Pain is
> localised bilaterally around upper chest, sternum and anterior rib joints
> (primarely costae I-III but also IV-V), somewhat more on left side. Also
> "burning" sensation in middle back (approx T3/4-T8) specially occurs with
> long standing or sitting at desk writing. Full AROM/PROM all periferal joints
> and spine except for painful facett joints and spinous processes during
> provokative testing/palpation of middle T-spine. Generalized
> triggerpoints/myofascial pain in muscles around shoulder
> girdle/trapz/rhombs/pecs. Pat also has a vague sense of wanting to caugh
> ("tickling" in chest area) after sitting still, which the MD told could be
> normally assiciated with the Tietzes syndrome...
The patient may not necessarily have Tietzes or costochondritis. The
symptoms might all stem from hypomobile joints in the area where he
feels the burning sensation. The feeling of wanting to cough may be a
result of somato-visceral reflexes in that area.
In addition to your treatment plan I would like to suggest the use of
the "sympathetic slump", a technique used for mobilisation of the
nervous
system (primarily the sympathetic trunks). It's suitable to perform
directly after mobilisation of the spine.
It is performed with the patient in longsitting (if possible), then the
patients whole spine (C+T+L) is gently guided in a combined movement of
lateral flexion and rotation to the same side, then go back to neutral.
This is repeated about 20 reps on each side. One can also add PA
mobilisation to the costae to the technique.
Good luck!
David Felhendler
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