DO - DEUTSCHE ZEITSCHRIFT FÜR OSTEOPATHIE (German Journal of Osteopathy) 3/2004
Thoracic Fascia Compression Trauma
Eric Hebgen D.O. M.R.O, IFAO, Königswinter
After traffic accidents, much attention is paid to whiplash injuries. But the apparently inconsequential compression caused by the seat belt on the thorax tends to be underestimated.
Patient and Symptoms:
A 49-year-old female patient, housewife, was suffering from movement-induced pain on the left side of the throat, radiating into the left arm. The suspected diagnosis indicated a cervical intervertebral disk herniation.
Medical History. A car accident five months prior had resulted in whiplash with headaches, limited mobility in the cervical spine, a feeling of blockage, and pain. At the time of the accident, the patient had been sitting with her seatbelt fastened in the back seat on the left, when the car had been hit with great force from behind. An x-ray examination detected abnormal straightening in the cervical spine, resulting in the diagnosis of whiplash. She was treated with a neck brace for one week, pain medications, and muscle relaxants. The headaches disappeared after ca. 2 weeks. The complaints in the cervical spine changed: The left side of the throat became increasingly painful with movement, and postural changes when resting triggered shooting pain in the neck radiating into the left arm.
- Intervertebral foramina - provocation test negative
- Cervical reflexes could be triggered equally on both sides
- Segment-indicating muscles, cervical: Degree of force 5
- Sensory impairments not attributable to any dermatome
- ULTT 1-3 according to Butler positive on the left
- Dysfunction in rib 1 and 2 on the left during inhalation
- FRS right TVB 2/3, TVB 3/4
- ERS left TVB 1/2
- Pronounced kyphosis in the neck
- Cervical spine mobility painful in all directions but free
- Shoulders protracted
- Diaphragms in inhalation on both sides
- Sternocostal joints 2-5 on the left clearly sensitive to pain (opposite side asymptomatic), mobility asymptomatic
- Left clavicle fixed in translation
- Major supraclavicular fossa (MSF) on the left clearly sensitive to pain, opposite side asymptomatic
- Fascial arm pull on the left halting in the pectoral area
- Ptosis of the small intestine
- Appendectomy scar with adhesions in the cecum, ascending colon, and right ovary.
- CRI reduced in frequency and amplitude
- High dural tension in the cranium, free sacrum
A neural root compression tested negative. The results suggested a disturbance in the neural slide bearing in the area of the brachial plexus (Thoracic Outlet Syndrome due to trauma). Great fascial tension in the area of the left ventrocranial thorax was noticeable.
Control Findings: CRI. Normalization of the first and second rib, as well as of the dysfunctions in the thoracic spine. Three-dimensional mobilization of the left clavicle, release of the MSF on the left, fascial mobilization of the left upper thorax area (height: ribs 1-5), normalization of the diaphragm, circulatory treatment of the small intestine.
The radiating pain in the arm was gone, the pain during head and neck movements remained unchanged, movements felt freer, and the CRI was normalized.
2. Treatment after 2 Weeks:
The pain in the left side of the neck had decreased. Findings: The left clavicle was still more firm than the right one, high fascial tension in the left upper thorax, sternocostal joints 2-5 on the left greatly sensitive to pain. Control Findings: Fascial arm pull. Treatment: Mobilization of the clavicles (also fascial), mobilization of the sternum and sternocostal joints 2-5 on the left, mobilization of the cervical and thoracic fascia ventrally and dorsally, release of the MSF on the left.
Fascial arm pull normalized. No change in the pain during head and neck movements. Condition 3 weeks after the second treatment: Only residual symptoms remained: Left side of the neck was painful during strong rightward lateral flexion of the head. The patient received two additional treatments until she was completely asymptomatic.
Discussion: The symptoms had been induced by the seatbelt. Even though it appears not to cause any injuries, the compression of the thorax is considerable and at a minimum leads to disturbances of fascial mobility in the thorax. These can then manifest as pathologies in the shoulder area, for example, or can be misinterpreted as in the present case as nerve root compression.
Conclusion: Impaired movement in the thorax does not attract attention if it "only" affects the fascia: Respiration does not appear to be affected, the joints of the thorax might still be able to move freely, but a respiratory palpation or fascial test of the joints and bones in the thorax can bring to light dysfunctions with high pathologic significance.