Thorax and Abdomen

Complex Pain

Xiphoid–Sternum–Clavicle Triangle

Indications

Sternum pain, painful sternoclavicular joint, painful sternoclavicular joint in the case of arthrosis, and conditions following clavicle fracture

Emphysematous thorax including xiphoid pain

Differential Diagnoses

Intestinal and mediastinal affections

Respiratory disorders

Material

Local anesthetic: 2.5 mL

Needle: 0.6 × 30 mm

Technique

The sternoclavicular joint is easily palpable. The clavicle is palpated up to its medial sternal end, where the palpating finger drops into a depression. The joint line can be palpated by moving the arm. The needle is inserted vertically 0.5 cm and 0.5 mL of a local anesthetic is injected.

This procedure is performed at both sternoclavicular joints and is followed by locating the xiphoid; this bone–cartilage process is usually distinctly pressure sensitive at one spot. The needle is inserted vertically 1 cm (observe the depth of insertion) and 1.5 mL of a local anesthetic is injected.

Risks

If the needle is inserted excessively deep and the joint line is missed, a pneumothorax may occur at the sternoclavicular joint.

If the injectable is administered excessively deep at the xiphoid process, abdominal organs may be injured.

Concomitant Therapies

Mobilization of the sternoclavicular joint using manual therapy

Postisometric relaxation of the rectus abdominis

Consistently exercising the levator scapulae

Stretching treatment for the shortened pectoralis major

!++

R 2 times a week, up to 8 weeks

MM, ThE, MET

Interscapular Pain

Indications

Interscapular pain

Thoracic syndrome accompanying obstructive respiratory disorders, for example, bronchial asthma

Differential Diagnoses

Affections of the pleural dome

Cardiac disorders

Material

Local anesthetic: 5 mL

Needle: 0.6 × 30 mm

Technique

A vertical line is drawn 3 cm lateral to the spinous processes. Along this line, the needle is inserted vertically every 2 cm.

At each site, an intracutaneous quaddle containing 0.5 mL of a local anesthetic is set, then the needle is advanced 1 cm and a further 0.5 mL of a local anesthetic is injected. Injections follow the pathway of the bladder meridian.

Risks

If the needle is advanced excessively, there may be the rare occurrence of a pneumothorax, especially at the vertex of the kyphosis; therefore, the depth of insertion must be observed.

Concomitant Therapies

Local warm peloid application, combined with mobilization of the subscapularis and lateral traction mobilization

Relaxation massages, acupuncture treatments

Hot jet blitz to the back, according to Kneipp

Chiropractic therapy

!++

R 3 times a week, up to 8 weeks

PhysApps, ThE, Met, Chiro

Therapy through Muscles, Tendons, and Ligaments

Pectoralis Major

Indications

Painful shortening of the pectoralis major accompanied by myotendinous irritation

Adjuvant treatment in emphysema

Adjuvant treatment in painful sternocostal joints

Adjuvant treatment in respiratory disorders

Material

Local anesthetic: 4 mL

Needle: 0.6 × 30 mm

Technique

Beginning at the mamillary line, the injectable is administered intramuscularly every 3 cm along a line that curves slightly laterally. Frequently, distinct pressure-sensitive myogeloses are found on that line. These points are fixed with the two-finger technique, the needle is inserted vertically 1 cm, and 1 mL of the injectable is administered.

In addition, a local anesthetic is always injected into the attachment at the upper arm. The inferior border of the pectoralis major is traced to the humerus. The needle is inserted 1 cm superiorly toward the bone until bone contact is made. After the needle has been retracted 1–2 mm, 1 mL of a local anesthetic is injected.

Risks

None

Concomitant Therapies

Especially physical therapy, including stretching and postisometric relaxation of the pectoralis major and pectoralis minor

Mobilization of the costovertebral joints using manual therapy

Medical assessment of the workplace or adequate assessment of motion sequences during athletic activities, if applicable

Friction massage of the pectoralis major

!++

R 2 times a week, up to 8 weeks

ThE, PIR, MM

Sternocostalis

Indications

Diffuse pectoral pain

Tietze syndrome

Sternocostal joint dysfunctions

Pain syndromes following rib fractures

Material

Local anesthetic: 0.5 mL per sternocostal joint

Needle: 0.4 × 20 mm

Technique

Initially, the sternum is palpated. From there, the finger moves laterally to the palpable sternocostal joint. The precise position is confirmed by having the patient inhale and exhale deeply; this allows the physician to palpate the motion within the sternocostal joint. The needle is inserted vertically 0.5 cm and 0.5 mL of a local anesthetic is injected.