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Differential Diagnosis and Treatment in a Patient With Posterior Upper Thoracic Pain

SJ Fruth, PT, MS, is Instructor, Krannert School of Physical Therapy, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227-3697 (USA)

(fruths{at}uindy.edu)

Background and Purpose. Determining the source of a patient’s pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain.

Case Description. The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises.

Outcomes. The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities.

Discussion. This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.

Key Words: Clinical decision making • Costovertebral and costotransverse joints • Differential diagnosis • Joint mobilization • Manual therapy • Rib • Trigger point • Upper thoracic pain