62 y/o male has been troubled by idiopathic upper thoracic pain and tension in the right upper trapezius and rhomboid muscles for 6 weeks.
He had been receiving regular massage and heat therapy which would relieve his muscular discomfort for 2 days.
He described the upper thoracic pain as a “blocked sensation” that he could not release.
Denies any pain or restricted range of motion involving the cervical spine.
There is a slight pain/restriction with chest breathing that he feels is most noticeable with deep inspiration.
When questioned about his previous medical history, he explained that he had been battling malignant bowel cancer for 7 years now. He had been through several bouts of chemotherapy and radiation therapy.
The upper thoracic pain would wake him up during the night. His weight had remained stable at 71kg.
Neurological examination unremarkable. No radicular signs. Reflexes intact bilaterally. Muscle strength good bilaterally.
Thoracic range of motion; flexion = 10 deg. extension = 15 deg. Left lateral flexion = 10 deg. Right lateral flexion = 10 deg.
Cervical range of motion; flexion = 35 deg. extension = 20 deg. Left lateral flexion = 15 deg. R lateral flexion = 15 deg. Left rotation 65 deg. Right rotation 60 deg.
Siump; positive for pain in the mid-upper thoracic.
Palpation; unusually tight and restricted joint play at T2/T3/T4 with prone P-A motion palpation and seated P-A motion palpation.
Vascular Testing; Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Treatment (at the initial consultation):
Education & Advice.
Targeted acupressure/ active releases at the upper trapezius and rhomboids
Seated upper thoracic facet joint distraction mobilisations
Referral patient for thoracic and cervical spine plain film X-ray imaging.
Metastatic spread to the vertebral body of T3.
Patient referred back to oncologist for treatment. Had several bouts of chemotherapy and radiation therapy over an 18 month period. Eventually the structural integrity of the T3 vertebral body was compromised severely and the patient needed spinal stabilisation surgery.
He continues to come in for cervical spine range of motion maintenance and diaphragmatic breathing retraining rehabilitation.