Osteopathic Treatment of the Clavicle and Rib

by Tyler Cymet, DO, FACOFP

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    00:01 The musculoskeletal system is linked.

    00:03 So pain in one place is often gonna manifest itself as pain in another place.

    00:07 and pain is often gonna coexist in multiple areas of the musculoskeletal system This is not unusual for a person with a kyphotic back to develop shoulder pain as it rotates inward and flexes forward.

    00:21 So we're gonna focus on the shoulder pain, and what could be causing the shoulder pain and try and localize it to the areas that are going to be affected.

    00:31 So a common cause of shoulder pain is gonna be clavicular dysfunction.

    00:37 So if the clavicle isn't working well, and I'm gonna check the clavicle, at the sternoclavicular junction and seeing if there's motion If there is adduction or abduction, or external rotation or internal rotation, or extension, or flexion - those things can cause pain in the shoulder Let's start with what I would do if this patient had ADduction of the clavicle.

    01:15 So I would try and localize the area - find the area, find the tender point if it's easy, or think about doing a muscle energy technique.

    01:27 And if I'm gonna be doing a tender point because I have an area that's soft, tender about 2 cm, Does that feel tender? Not really? For purposes of the video, we're gonna say this is tender though.

    01:42 and then I would try and find an area of ease where I feel some easing up the muscle, do some internal rotation and find an area Once I find an area of ease, and assume that the pain is gone and you get 70% benefit with positioning, you can hold it for 90 seconds, allow it to ease up, and return.

    02:11 So for muscle energy procedure, you gotta find the sternoclavicular junction, and I'm gonna have him use his muscles to free it up and to relieve some of the pain.

    02:24 So what I would do is I would bring him closer to the end of the table, A little more, good.

    02:32 Get the sternoclavicular junction, take the arm, put it in a little bit of extension, a little internal rotation and then have him lift his arm up.

    02:44 Let me have you put pressure going forward Good.

    02:48 and relax.

    02:49 So 3-5 seconds and then relax, 3-5 seconds push again One, two, three, four, five - relax.

    02:57 and get more And this will help free up motion and the clavicle Let me have them move back a little bit.

    03:06 If he has an extension lesion, I'd want to have him hold my shoulder, I'm gonna check the clavicle and pull the scapula as well.

    03:19 There are a couple ways of doing this.

    03:21 I can have him push down on my shoulder with his arm therefore pushing his scapula backwards or I can have him push his shoulder down towards the table and which one is more comfortable? (left to shoulder) Left to shoulder down? So let me have you push the shoulder down towards the table, and I'm gonna monitor the clavicle.

    03:41 Push - one, two, three - relax.

    03:47 And I'm gonna push the proximal portion of the scapula deeper posterior In that way the distal portion will go anterior.

    03:56 Push down the shoulder again.

    03:59 one, two and three - and relax.

    04:02 and I'll lift it up.

    04:03 and one more time, push down with the shoulder One, two, three - and relax.

    04:11 and that's how I would treat a muscle energy procedure for the clavicle.

    04:17 Another common cause of shoulder pain is going to be rib dysfunction.

    04:23 and when you look at the rib tender points, the tender points are both anterior and posterior.

    04:28 From an anterior perspective, tender point number one For rib number one, it's gonna be under the clavicle where it meets the sternum, So just underneath is gonna be tender point number one for rib number one.

    04:44 That's a difficult way and a tender way to get to the rib, but that's how you're gonna find the tender point.

    04:50 Rib number two is gonna be in the midclavicular line right below this second intercostal space.

    04:58 (rib) 3, 4, 5 are going to be medial just to the side of the sternum - so three, four and five There are also going to be anterior axillary line points for ribs 3, 4 and 5 on the rib Let me have you sit up Posteriorly, you're going to have tender points at the angle of the rib from T1 all the way down to T12 So let me have you lay down again.

    05:36 In treating the tender points, basically you find the tender point, and then have them look at it.

    05:42 I'll flex the neck, sidebend and rotate towards it so he sees the tender point In the ribs, this is different than the other tender points.

    05:53 We hold this for 120 seconds not the standard 90 seconds These are the ribs, they got 120 seconds of looking at the problem, relaxing and then letting them return to midline and reassessing Again the important part with shoulder pain, with chest pain is always starting with the diagnosis, knowing what you're treating, treating it and assessing the effectiveness of your treatment.

    06:21 Thank you.

    About the Lecture

    The lecture Osteopathic Treatment of the Clavicle and Rib by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Osteopathic Treatment of the Clavicle and Rib

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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