Regis Mani Aaompt Poster 2008

USE OF THRUST AND NON-THRUST MANIPULATION FOR COSTOCHONDRITIS: A CASE SERIES. Kaarthick Mani, PT, DPT, MS Fellow - Regis University Manual Physical Therapy Fellowship Program

Manual Therapy Fellowship

Orthopaedic Physical Therapist, Orthopaedic Therapy Specialists LLC, Warrenville, IL

Approximately 50% of patients attending accident and emergency departments and out patient cardiac clinics because of chest pain have a non-cardiac basis for their symptoms. They are often given a non-specific (1) diagnosis. It has been suggested that the costovertebral and costotransverse joints are commonly overlooked (2) sources of atypical chest pain.

NPRSInitial vs. D/C

Pain Scale 010

10

0

NPRS(D/C) NPRS(Initial) Case 1

Case 2

Case 3

NPRS(Initial)

8

9

8

NPRS(D/C)

2

0

4

Chest ExpansionDifference incm

10

AverageChest Expansion (U,M, &Lower)

Purpose: To describe the examination and manual physical therapy interventions for patients with subacute/chronic episodes of recurrent upper thoracic/chest pain. The purpose is to outline the use of thrust, nonthrust mobilization/manipulation techniques, rib muscle energy techniques (MET’s) combined with exercises for individuals with a diagnosis of costochondritis.

Baseline & Discharge (D/C) Findings

5 0

Chest Expansion (Initial) Case 1

Case 2

Case 3

Chest Expansion (Initial)

2.3

2

2.5

Chest Expansion (D/C)

6.3

4.16

4.1

Conclusion: These patients experienced a rapid improvement in pain and functions after non-thrust and thrust mobilization/manipulation and rib MET’s to thoracic spine region. Clinical Relevance: A combination of thrust and non-thrust mobilization/manipulation, Rib MET’s and scapular strengthening exercises may be helpful for patients with a diagnosis of costochondritis. References: (1) Capwell S, McMurray J. “Chest pain – please admit”: Is there an alternative? British Medical Journal 2000;320:951-2 (2) Rabey MI. Costochondritis: Are the symptoms and sign due to neurogenic inflammation. Two cases responded to manual therapy directed towards posterior spinal structures. Manual Therapy 13(2008):82-86