Case Report: The patient was a 23-year-old Caucasian female of otherwise normal and healthy appearance who presented to a local university student health center with severe pain at the medial aspect of her right breast and a large part of the right hemithorax. Movement of the right arm exacerbated the pain, particularly at the costovertebral and costosternal articulations. The area surrounding the right breast was exquisitely tender. The musculature in the region was tender and in spasm with multiple myofascial trigger points. Motion assessment revealed joint hypomobility throughout the cervical and thoracic spine and at multiple costosternal and costovertebral articulations. Therapy primarily consisted of chiropractic manipulative therapy (CMT) in conjunction with manual trigger point therapy (TPT) and electrical muscle stimulation. Initial treatment was extremely gentle. However, with each subsequent treatment, more aggressive CMT and TPT were possible. Ultimately, stretching exercises were added. After six weeks of treatment, the patient had minimal, intermittent discomfort, and was able to resume her job as a swimming instructor.
Discussion: Patients with Poland’s syndrome may need several surgeries for cosmetic or functional reasons. In some cases, post-surgical pain results due to fascial and myofascial restriction and joint hypomobility. Additionally, unique biomechanical alterations may be present as a result of anomalies seen with this syndrome. Effective relief of pain in post lumpectomy patients using myofascial release has been reported in the literature. However, a search of the literature did not find any previously reported cases of chiropractic management of post-surgical complications in patients with Poland’s syndrome. This case demonstrates the successful use of CMT, TPT and therapeutic exercise in the management of post-surgical pain in a patient with Poland’s syndrome.
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