What to make of thickened skin over C7-T1

Hi everyone!

I have this female pt, 50yo who c.o of bilateral upper limb Symptoms and neck pain. She has developed a very kyphotic posture in the upper T/S and very lordotic mid C/S.

What I don't understand is the nature of her skin over the cervico thoracic junction. She has developed a considerable thickening of the skin which resembles a patch. It doesn't wrinkle and it moves as one. So when I do a tranverse on her C6 lets say, the 'patch' which is 2cm away, moves in the direction i'm applying the force. And there appears to be a focal point somewhere around T1, as if there's a thread under the skin that keeps it to that specific point.

On the MRI nothing has been reported but I can clearly see the fat tissue being much thicker at the area. There is no discoloroution over the area.

Should I take this as a hypomobile connective tissue with trophic changes?
I would appreciate any imput,

Thank you!

Dear Ingedik,
What you are describing sounds very much like a connective tissue zones. These zones were first described by E. Dicke and Teilrich Leube in 1950´s.
They are: Zones that are visible on the surface of the body – skin and connective tissue
They occur in dermatomes which have a clear identifiable segmental relationship either;
sharing 1. the sympathetic supply of a viseral organ (stomach or lungs)
2. sharing a function (venous circulation)
They either appear as tight in-drawn area, often with oedeem around the edges and often, especially around C7T1 they appear as big oedematous patches. I have seen many of them in my time.

They are a sign that the circulation is not what is should be.
I have often treated them with bindegewebsmassage, or another therapy that can influence the autonomic nerve system such as acupuncture.
I do not know if this therapy ever made its way to your country.

I do not have time to look up articles for you at this moment.
look up Elsevier and go from there. There is some some information out there.. all you have to do is search......Liz Holey has written several articles on this subject.

kind regards

Esther

Dear Esther,

Thank you for taking the time to reply to my question.

I'm not familiar with bindegewebsmassage but I will look it up. Some of us do practice trigger point dry needling here in Greece, so it might be something I can keep in mind. I'm definitely looking up Liz Holey straight away!

Thanks again,
Regards
Ingrid

Dear Ingrid,

If you or your colleagues, do decide to treat these problems with dry needling, please keep me informed...... could be an interesting new extra option......

Esther

The theory behing it would be to treat all points and muscles of that level and corresponding dermotomes but as i'm unfamiliar with connective tissue zones I am still researching my options.

I had a look at the literature-thank you for the suggestion-but I haven't managed to find a good description of what exactly the connective tissue manipulation is. There is a description in the 3 articles by her but it's not descriptive enough. I've searched the web for something better but this is the closest I get. I understand you stretch the tissue and it all depends on the distal interphalangeal joint, but then how do you produce the stroke? Do you tap with the other hand? Are you supposed to feel or hear anything as you're performing it?

I'll list the 2 articles that I've found in case anyone else is interested

• Connective Tissue Manipulation, Towards a Scientific Rationale, Liz A. Holey, Physiotherapy, Dec 1995, vol. 81, no. 12

• Connective tissue massage: a bridge between complementary and orthodox approaches, E.A. Holey, Journal of bodywork and movement therapies, january 2000

Dear Ingedik,

First of all, you cannot expect to learn a massage technique, through this forum. Sorry for that.

The postgraduate courses take at least 40 hours. You have to learn to assess the zones, to decide whether they are meaningful yes or no. You have to understand their meaning and decide IF you treat. And then, it takes time to learn this technique.


Sorry for that.....
I find the skin stimulation technique the best. See if you can find a colleague that was trained in Germany or Holland. They might be able to teach you. One ground "rule" is, do not start at the zone but start on the lower back.

kind regards

Esther