Ortho/Neuro Concerns: A Case Study
A 28-year-old female patient encountered a stress injury affecting her lower extremities about a year ago, which necessitated a six-week period of immobilization using crutches. Shortly after being cleared to resume weight-bearing activities, she began to experience debilitating muscle soreness and stiffness in her upper body without any identifiable trigger. This was accompanied by episodes of involuntarily clenching her teeth at night, requiring her to get fitted for a dental retainer due to the hypertrophy of one of her jaw muscles. Additionally, she dealt with symptoms of unilateral neurogenic thoracic outlet syndrome (NTOS), unexpected fluctuations in heart rate and blood pressure, nausea, loss of appetite, overwhelming fatigue, and feelings of derealization. After four months of physical therapy, she consulted an orthopedist who suspected NTOS and recommended continuing therapy. Laboratory tests were also carried out to exclude any underlying physiological issues, including autoimmune conditions. Remarkably, following nearly five months of these distressing symptoms, an incident occurred one morning when she rolled over in bed and heard a distinct crack originating from either her shoulder or scapula. Almost immediately, her symptoms alleviated significantly. Her current physical therapist posits that this could have been due to an undiscovered rib subluxation impinging on her vagus nerve, leading to her previous symptoms. Fortunately, the majority of her autonomic symptoms have resolved, yet she continues to suffer from NTOS, along with persistent discomfort in her scapula and collarbone, which often feels misaligned. She also experiences notable tightness and pain in her trapezius and rhomboid muscles. Her therapist suggests that rib flaring may be contributing to her issues, but the sensations she's experiencing lead her to believe the situation might be more structurally complex. She seeks insight into what these persistent symptoms might indicate and the appropriate next steps she should undertake. Having been engaged in physical therapy for ten months and consulting multiple therapists without significant improvement—aside from the remission of her autonomic symptoms post-crack—she finds herself in need of guidance. There is no documented history of upper body trauma or diagnoses of connective tissue disorders, and all blood tests returned within normal limits. Any recommendations would be greatly appreciated. Thank you!
Answers (1)
7/6/2025, 3:30:53 AM
OpenHealth AI
Main Points: Persistent symptoms after a stress injury and prolonged therapy can be frustrating and complex. Your situation may involve a combination of muscular imbalances, residual stress from previous injuries, and possibly ongoing thoracic outlet syndrome (NTOS). It’s essential to continue addressing these issues proactively.
Explanation: Your history suggests that the underlying causes may be multifactorial. The persistent discomfort in your scapula and collarbone, along with the tightness in your trapezius and rhomboid muscles, could relate to muscular tension from compensatory patterns developed during immobilization and therapy. The incident where you heard a "crack" may have temporarily relieved some tension or altered nerve compression but didn't fully resolve the structural issues.
NTOS can lead to symptoms like pain and discomfort in the upper body, especially if there is compression in the neck or shoulder area. This can aggravate muscle soreness and tightness, and rib flaring might indeed play a role in your discomfort.
Next Steps:
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Continue Targeted Physical Therapy: Focus on a physical therapist with experience in upper body biomechanics and neurodynamic techniques for NTOS. Seek specific exercises that target rib mobility, shoulder stability, and muscle relaxation.
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Breath and Posture Work: Incorporate breathing exercises to help alleviate rib flaring and promote better postural alignment. Diaphragmatic breathing can support rib cage alignment and reduced muscle tension.
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Explore Manual Therapy: Consider integrating a method known as myofascial release or chiropractic adjustments, specifically targeting the ribs, thoracic spine, and shoulder girdle, as this can help in restoring alignment and reducing tightness.
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Self-Care Strategies: Implement regular gentle stretching routines focused on the upper body, as well as heat therapy (like a heating pad) to alleviate muscle tension. Regular low-impact activities like swimming or yoga may be beneficial.
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Mind-Body Techniques: Consider adding relaxation techniques such as meditation or mindfulness to help manage pain and support muscle relaxation, especially given your history of involuntary clenching at night.
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Monitor Symptoms: Keep a symptom diary to track the intensity and triggers of your discomfort. This documentation can be helpful when discussing your progress with healthcare providers.
If symptoms persist or worsen, consider a reassessment of potential structural issues with a specialist experienced in thoracic outlet syndrome or consult a pain management specialist for advanced treatment options.
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