The Five Osteopathic Models by Fusco Giampiero & Lunghi Christian & Tozzi Paolo & Hruby Ray

Author:Fusco, Giampiero & Lunghi, Christian & Tozzi, Paolo & Hruby, Ray
Language: eng
Format: epub
Publisher: Handspring Pub Ltd
Published: 2018-07-04T16:00:00+00:00

Case study

Woman, 38 years old, Caucasian, employed, non-smoker.

Presenting complaint and past history

For about 5 months, after a collision associated with an attempted theft of the vehicle, she has suffered neck pain that extends from the neck and radiates into the left inferior orbit, to the mid-thoracic spine, occasionally to the shoulder and left arm during abduction or if the elbow rests on the table, but does not extend to the hand. The pain is present during the day, gets worse with movement, and is accompanied at times (such as on the day of the visit) by pain in the lower back, left buttock, and posterior left thigh, but the patient states the pain does not radiate to the lower leg. The pain disturbs sleep during movements in bed and gets worse when the patient wakes up. The pain is alleviated with the use of a cervical collar and ibuprofen. Sometimes there is nausea, blurred vision, dizziness, slow digestion, and postprandial fatigue.

Hospital report

Distortion of the cervical spine.

Diagnostic investigations

Cranial CT scan: negative. Cervical spine X-ray: flattening of the cervical spine. Echo Doppler supraortic trunk (TSA): arterial axes regularly explored for size and course bilaterally; regular caliber of the common carotid, with density of the intima media in accordance with established norms bilaterally. Left: bulb and bifurcation vessels without significant lesions. Right: findings similar to the left side. Patent vertebral artery with orthodromic flow in VO–V1 and V2 explored bilaterally (dominant left).

Past medical history

Before the trauma the patient had no muscle disorders. In the past: intermittent stomach pains (no reflux) associated with irregular cycle (5 years before). Occasional premenstrual pain.

Social and occupational history

Very active during work, but after the trauma is afraid to drive because of the attempted robbery of the vehicle. Played sports (volleyball); good lifestyle; absence of economic problems.

Differential diagnosis

Disorders associated with whiplash/spinal cord syndrome compression.

Objective examination

•​Sharp–Purser test: negative

•​Test of compression of the spine in flexion, extension, rotation, sidebending: negative

•​Tests of spinal distraction: positive with cervical and left shoulder pain

•​Brudzinski, Kernig, and Romberg signs negative

•​Osteotendinous reflex: 2+ (normal)

•​Absence of signs of motor deficits

•​Adson test: positive on the left, with the head rotated left

•​De Klein test, bilateral SLR test, Nachlas, Manson and Slump test: negative

•​Peripheral pulse: 70 bpm, regular.

Assessment of sensitivity

•​Superficial allodynia, left cervical paraspinal tract

•​Primary hyperalgesia average in the thoracic spine

•​Secondary hyperalgesia buttock and left thigh

•​The patient reported pain as 9/10 on VAS scale

•​The pain does not change from sitting to standing

•​Adverse neurological tests: neurological syndromes are excluded.

Evaluation of orthostatic posture

•​Reduction of the physiological curves with anterior cape

•​Right inferior iliac crest

•​Inferior right PSIS

•​Lumbar convexity to the right, thoracic convexity to the left

•​Right shoulder inferior

•​Head sidebent left and rotated right.

Evaluation of breath

Regular breathing (14 per minute) primarily upper thoracic.

Osteopathic evaluation

Global test

•​FCT (meningeal fascia): reduction of meningeal fascia mobility

•​FCS test: decompensated

•​DyFIR GA: not balanced

Segmental tests

•​Red reflex: positive bilaterally C5–T1 area

•​Skin drag: positive T8–T12 area

•​Beal’s compression test: positive T8–T12 left tract.

Local tests

On palpation there is dysfunction of the soft tissues in the muscular area under the neck, with radiation of pain to the left

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