Anterior Chest Pain - ? Local Impingement

[ChrisMorr]

Update!

The patient came back to me towards the end of last week. She reported that she found good relief from the treatment for approximately 24hours. However, the morning after the treatment she was sitting in the passenger seat of a car and reached backwards to grab something off the back seat, which markedly increased her symptoms and has been present since this, to a greater degree than ever previous.

I rechecked her cervical segments with NAD. She has reduced ROM with all shoulder movements secondary to pain, particularly internal rotation which is a huge aggravater, in the hand behind back test she cannot get past her PSIS secondary to pain. She continues to have NO peripheral neural symptoms. She describes the pain as a strong, burning sensation particularly at night, which appears consistent with neural type pain.

My train of thought is now heading towards a brachial plexus traction type injury, as mentioned by physiobob, and given the limited success of the individual neural mobilizations. I spoke to the GP and he will prescibe a neural type analgaesic and i will re-review her after this course is completed. There appears to be no musculoskeletal or vascular injury remaining, but i am still confused by the lack of peripheral symptoms in the neural complexes are at fault.

[quorthon]

my opinion dear colleague, is that if there was a true NEUROLOGICAL lesion (either on cervical roots or on brachial plexus) there would be true NEUROLOGICAL signs and syptoms....This means that your client should have paresthesia in a more peripheral site (which she doesnt have as u mentioned) and some form of weakness in muscles of upper limb (especially if she has more severe clinical presentation)...And speaking about Brachial Plexus lesions, they more often compromise A8-T1 roots...If there are respective signs and syptoms due to those roots then u should consider that neurological tissue is pathological involved

P.S. the aggravating factor u mentioned (reaching the back seat of the car) is true CERVICAL-induced...She probably rotated her neck for that