This topic contains 4 replies, has 3 voices, and was last updated by Christopher Stepien December 25, 2019 at 12:59 pm.
December 17, 2019 at 6:41 am #8828
25 YO female
Left lateral lower rib cage
Q: Sharp, tight, “feels like it’s going to snap”
I: 5/10 when provoked (3/10 at rest)
Prov: heavy breathing, when bloated from eating, any CrossFit or strength workout
Pall: rest, squeezing the ribs
1. Intercostal rib adhesion
2. Something else ???
2nd Order Hx Points
O: April 2019 (suddenly), the day after going off antibiotics from an infection in her tooth.
After April 2019, had fluid around her left lung and heart. A few weeks later, a pulmunologist said the fluid was gone. MRI chest and spine said “fine”. The pain, IN APRIL 2019, was also under her left clavicle, in her left pec and under her anterior left lower ribs (all of this is suggestive of LUNG involvement to me). Said it felt like “cheerios” over her lower ribs when she breaths (maybe suggestive of instability?)
In May 2018, diagnosed with idiopathic urticaria angioedema (no fever, but hives and swelling).Was on 15 meds/day. Was able to go off them when she went on an anti-inflammatory diet. She was in bed almost all day from May 2018 to Sept 2018.
Had depression from 15-22. Scarlet fever at age 11. Tourettes syndrome at 12. Diagnosed with epstein barr in May 2018 (but no signs of it).
TR – R: 74 deg, 134% – mild tightness left ribs
TR – L: 59 deg, 107% – mild pain left ribs (At Treatment 1, this regressed to 48 degrees with severe pain – suggestive of inflammation somewhere restricting this motion)
SA – of – No symptoms
Scap E/D – Full – no symptoms
Cervical LF with Shoulder depression – full, no symptoms
Palpation: Moderate adhesion in intercostals, NO adhesion in Left QL
– Standing and taking heavy breath (4/10)
– Standing, laterally flexing lumbar sine to right with left arm overhead
– (5/10 tightness at CCx)
1. Intercostal adhesion due to fluid around lungs from antibiotics
1. Am I missing anything?
2. After 2 treatments, I felt minimal adhesion in her intercostals left. I’m going to check on her at home and tell her NOT to come on for visit 3 if no other relief.December 18, 2019 at 9:22 am #8830
Seth Schultz, DCParticipant
Did you do FastMap for her Chris?December 18, 2019 at 12:48 pm #8832
Doing now. TY for reminder of Fast MAP Seth.
I assume “established pattern” means “sclerotegous” or “dermatomal” referral pattern?
Where would I go from here?December 19, 2019 at 4:49 pm #8842
Carl Nottoli, DCParticipant
Established pattern means sclerotome, dermatome, peripheral nerve, or myotome. I suggest watching a refresher on the Fast Map webinar.
Lots to unpack here. Her initial Sx primarily pointed to the metabolic issue as the culprit. She has great ROM and constant pain.
I think you did the right thing by treating what adhesion was present in the region, and stopping as soon as you suspected something else. There’s a possibility that the innermost intercostal muscles have adhesion. These are deep to the external and internal intercostals, responsible for forced expiration now may be having difficulty expanding properly. I’m not sure if we treat these with MAR. There also may be other connective tissue adhesions internally from the inflammation that cannot be treated manually.December 25, 2019 at 12:59 pm #8856
Very helpful Carl.
I will watch the Fast Map webinar! TY for input.
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