D8 D9 pain

[utkarsh777]

Hey,
i got this patient.. he has painful spinous process D8-9.. the pain increases with rotation.. both side. Flexion, Extension, Lat bending produce no pain orrestriction.. the patient was having Pt done at some government setup with Short wave diathermy and Ultrasound which gave no relief..

I've manipulated him using CYRIAX.. Distraction to spine then force on problem segment.. the patient had immediate relief.. his rotation range increased and became non painful.. but after 3-4 hrs the pain returned.. he has had 3 sittings with me.. wat do i do??

patient is 35 yr old male and has had the pain for 8-9 months now.. PLZ HELP????

Thanks..

[neurospast]

What do you mean with D8-D9 Thoracic I assume. otherwise I am completely confused.
In case you have manipulated thoracic. What have you maipulated; the vertebraes T8_T9 or Costa T8- Vertebra T8 -T9?
What I try to point out is that it is easily done. Anyhow what sort of pain are you talking about, sharp? dull? burning? Does it radiate? Whereto? Contuous pain? Why did you choose manipulation?
Diff diagnose; blockade of joints? Triggerpoint(s)? (referred pain in which area?)
referred pain does it go towards the front (from medial more lateral or from cranial to dorsal?
Palpation where does it hurt.
I think the reason for the immediate return is that you do not solve the problem. In case of p.e. a triggerpoint in a muscle the muscle might relax for a short time or alike but comes back immediately.
The way forward is to find the triggering factor and then start your treament. Be aware that there might be several triggerpoints in the area so look at a `map`ala travell and show it to your patient. You can try acupressure / US but to my experience the best is acupuncture in these cases.
By the way 3sittings with manipulation?

[alophysio]

Hi.

Perhaps he has a rotational instability problem at the CV joints.

Diane Lee has an article in manual therapy 1996 on rotational instability of the mid-thoracic spine-access thru your library for more ideas...

[bsandeep]

Has the patient been investigated?do you have MRI or x-rays of the dorsal spine? pain for period more than 9 mths i think early infective pathology(koch's) has to be ruled out before manipulation

[arunja]

Hi
I think what you have done is perfect. I believe that it may be a hypomobility which usually restricts the rotations. It has nothing to do with the lateral flexion. The maitlands techni will resolve it , but also check for the occcupation of patient , whether he used to sit for a long time , which may aggravate condition, probably 3 to 4 sittings will relieve the situation completely.

[mageshanand]

HI there guys,

I completely agree with neurospast and sandeep, before you go on with manipulation, there are lot of screening to be done, anyways assuming that you have done all the needed screening, you might want to assess the myofascial component as well, by the way the pain that you said which returned - is it the same old pain or a new pain in terms of type, severity etc,

i feel if you can give more explanation on the assessment of this patient we can give a better suggestion on going about this case,

i hope others also agree with me,

see ya man,

hope to get back you soon