Anterior Chest Pain - ? Local Impingement

[physiobob]

I think your observations and treatment seem to be related as the symptoms resolved somewhat following. Maybe though there was a traction injury. For sure she would have a whiplash from the landing but also a traction to the brachial plexus. You mention the apex of the lung. This is rather high in anatomical terms under the upper fibres of trapezius. I suppose some scalene involvement might also be suggested in trying to prevent the impact on the neck. I'd continue working along the lines you've begun. Show a self stretch for the radial nerve. Perhaps give retraction & Ret/rot in supine with a towel supporting the head (ala McKenzie or Mulligan).

If things only get better transiently (always going back to the way they were) and also if there are any discoloration to the upper limb on that side don't rule out a DVD in the subclavian etc. This is an uncommon but real hypothesis that can mimic nerve pain. I have seen it once and I remember a missed diagnosis in the 90's of an uncle toby's iron man by a Sydney physio that got a few people in hot water.

Anyway let us know how you got on.

[quorthon]

u havent reported if the onset of pain was exactly AFTER the accident, or the anterior chest pain was developed during this time interval (10 months) for no apparent reason....I would agree with Physiobob about the supplements u could make on your regime and i will remind you that CERVICAL DISCS has a huge potential of referring pain on anterior chest pain....Check Slipman articles on cervical discography on pubmed...You should use Mckenzie principles (i am not sure that only retraction/extension will do the job) but beware to make proper mechanical diagnosis (dont know if you are familiar with the method) because other forces than retraction can be indicated (for example lateral flexion).
And my advise on "nerve mobilisation" techniques as you have mentioned: its just a waste of time...Many times these maneuvres elicit false-positive results (nerve tissue is MECHANOSENSITIVE so DONT IRRITATE it by any means!!!) and despite some "early" positive results u may gain, u will rarely get positive outcomes counting only on these (as i often observed on practice)