The patient is a 30-year-old nail technician who presents to our clinic with complaints of acute and sometimes burning pain in the mid-back, between the shoulder blades. The intensity of the pain increases significantly by the end of her work in the salon. Do you have any suggestions on the cause based on visual observation?
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Please compare the right and left parasternal areas, paying particular attention to the right side of her upper chest. There is a visual bulge in her right parasternal region (indicated by blue arrows in the photo).
Thus, the patient’s anterior chest suggests the possible presence of an early stage of Scoliosis with thoracic curvature directed to the right.
The patient suggested visiting her family doctor, who referred her for an X-ray. Radiologist confirmed the 1st-stage of thoracic curvature (indicated by the blue line on the X-ray).
The 1st stage means that during her late puberty, the thoracic vertebrae began to rotate, and curvature started to form before she stopped growing. Secondary curvature in the lumbar spine didn’t form since she stopped growing.
At this stage, Scoliosis can be suspected clinically by observing anterior chest differences or deviation of the spinous processes when the patient bends forward in the standing position and the therapist runs fingers along the line of the spinous processes.
The presence of visual differences in the parasternal areas is due to the upper ribs’ anterior displacement caused by the rotation of the bodies of the upper thoracic vertebrae. In this scenario, it is useless to treat her middle back pain since the upper thoracic curvature must be decompressed first.
Her symptoms were completely eliminated after three sessions of the Medical Massage protocol for Scoliosis. Therapy included detailed work layer by layer on the soft tissue on all sides of the chest, utilizing stimulating techniques on the convex side and inhibiting techniques on the concave side of the curvature. This was achieved through the decompression of curvature via stretching, the application of respiration-resisting techniques, and homework.
The vertical decompression of the thoracic curvature using a chin bar after a hot shower will allow her to live a productive life without pain and dysfunction.
CONCLUSION
Early stages of scoliosis are frequently missed by parents and pediatricians. However, they cause different somatic symptoms later in life. Since curvature(s) are mild, their presence can be suspected if the therapist knows what to look for, and a basic X-ray will confirm or reject suspicions. So, always check the position of the shoulders, scapulae, and anterior chest, comparing both parasternal areas to be sure that you are taking appropriate steps and knocking on the correct door.
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