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An Osteopathic Approach To Refractory Sternal Pain

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 13. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/10/493538/LBORC-NUFA-Poster-Abstracts-2023-Residents)

Keywords:

case report [514]
chest pain [11]
female [379]
OMT [2951]
osteopathic manipulative treatment [2973]
sternum [4]
thoracic spine [56]
women [333]

Abstract:

Introduction/Background: Chest pain causes can be cardiovascular, pulmonary, musculoskeletal, gastroenterologic, and psychogenic. A 2013 review¹ showed that chest pain accounted for 1 to 3% of PCP visits, with 21% to 49% of the chest pain diagnosed as musculoskeletal in origin. Serious underlying cardiac or gastrointestinal issues are typically ruled out initially, however if origin is deemed to be musculoskeletal, options for conservative therapy (NSAIDS, topical creams, injections, stretching, PT) are non-specific and can be lacking in effectiveness. Case: A 58 year old female with history of multiple car accidents who presented for several-year history of generalized sternal pain refractory to multiple different anti-inflammatory medications and gels, previous sternoclavicular injection, and several courses of physical therapy. Cardiac and rheumatologic work up were negative and MRI showed mild bilateral sternoclavicular joint arthropathy and incidental small hiatal hernia. Pain was thought to be secondary to costochondritis with osteopathic exam revealing thoracic/posterior rib dysfunctions, SC joint restrictions, and manubrial fascial restriction. Over 3 months, she had monthly OMT treatments mainly focused on muscle energy and myofascial treatments to her thoracic spine, ribs, sternoclavicular joints and sternal fascia. Results: The patient experienced significant relief of her symptoms after each treatment. She reported up to 70% relief after each treatment and was able to decrease her pain medications, including discontinuing twice per day gabapentin, as well as decreasing frequency of as needed Celebrex. Discussion: Sternal pain can be caused by a multitude of issues, including serious cardiac or GI origins. However, if these underlying causes are ruled out, there are not many well-established conservative treatments. OMT should be considered as a first-line treatment for patients with sternal pain of musculoskeletal origin.


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