Re: [OregonDCs] Pectoral Pain

[Guest guest]

6’5”? Marfan’s with cardiac involvement?

Angina Pectoris?

Seitz, DC

From:

[mailto: ] On Behalf

Of Dr. ph Medlin D.C.

Sent: Friday, June 01, 2007 12:43

PM

Subject: [OregonDCs] Pectoral Pain

Hi folks,

34 year old female 6'5 " former water polo player

complains of knife like sharp pain in upper right pectoralis region near it's

attatchment to humerus and in area of inferior clavicle. SHe is large breasted

(very large). Has " episodes " of debiliating pain in the region

and then it subsides. Worsened by lying down supine.Pain is reproduced (even if

asymptomatic) by probing the area with even light palpation. It makes her jump.

At first i thought ribs, then damaged pec attatchments or clavicle

displacement. Treatment of these has produced no relief as of yet (soft tissue

work, rib adjusting, pectoral stretching, ice, heat) I have no films

of the area, which may be a good idea at some point, but this has been going on

for a while. Theres no radicular pain. I'm baffled.

ANyone see something like this before???

ph Medlin, DC

Spine Tree Chiropractic

1627 NE Alberta St.

Portland, OR

97211

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[Guest guest]

Had a guy with the same presentation (without the large breasts).

He had an MRI which showed a partial tear of the supraspinatus.

Made no sense at all.

Sometimes patients forget to read the textbooks.

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: " Dr. ph Medlin D.C. " <deadmed@...>

Date: Fri, 1 Jun 2007 12:42:55 -0700

< >

Subject: [OregonDCs] Pectoral Pain

Hi folks,

34 year old female 6'5 " former water polo player complains of knife like sharp pain in upper right pectoralis region near it's attatchment to humerus and in area of inferior clavicle. SHe is large breasted (very large). Has " episodes " of debiliating pain in the region and then it subsides. Worsened by lying down supine.Pain is reproduced (even if asymptomatic) by probing the area with even light palpation. It makes her jump. At first i thought ribs, then damaged pec attatchments or clavicle displacement. Treatment of these has produced no relief as of yet (soft tissue work, rib adjusting, pectoral stretching, ice, heat) I have no films of the area, which may be a good idea at some point, but this has been going on for a while. Theres no radicular pain. I'm baffled.

ANyone see something like this before???

ph Medlin, DC

Spine Tree Chiropractic

1627 NE Alberta St.

Portland, OR 97211

[Guest guest]

: You are brilliant. I didn't even pick up on the extreme height of the woman. Holy cow! Ann

RE: [OregonDCs] Pectoral Pain

6’5”? Marfan’s with cardiac involvement? Angina Pectoris?

Seitz, DC

From: [mailto: ] On Behalf Of Dr. ph Medlin D.C.Sent: Friday, June 01, 2007 12:43 PM Subject: [OregonDCs] Pectoral Pain

Hi folks,

34 year old female 6'5" former water polo player complains of knife like sharp pain in upper right pectoralis region near it's attatchment to humerus and in area of inferior clavicle. SHe is large breasted (very large). Has "episodes" of debiliating pain in the region and then it subsides. Worsened by lying down supine.Pain is reproduced (even if asymptomatic) by probing the area with even light palpation. It makes her jump. At first i thought ribs, then damaged pec attatchments or clavicle displacement. Treatment of these has produced no relief as of yet (soft tissue work, rib adjusting, pectoral stretching, ice, heat) I have no films of the area, which may be a good idea at some point, but this has been going on for a while. Theres no radicular pain. I'm baffled.

ANyone see something like this before???

ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211

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[Guest guest]

Thanks for all the responses folks. Marfans wasnt considered because she is a large woman, voloptuous shall we say, and her father is 7 feet and two sisters above 6'2" No history of it just big folks. Cardiac involvement was not considered simply because of location (right sided) and symptoms. there is no symptoms with exertion etc. only with light probing or when it flares up and proffers knife like sensations in the area. I've been treating her for a variety of things, but I've treated this particular problem for approx, 4-5 treatments. SHe'll need more I know.

Bicipital tendonitis was ruled out via ortho testing etc. Again, this is something that even with VERY light touch (surface palpation) can send her through the roof. However, I've noticed that she is a bit sensative in that way to many "sore" spots that are located. As a matter of fact, the left side is also a bit sensative in same areas, but not to the degree it is on the right, so large breasts may still be causing problems. I have not discussed breast reduction as of yet, perhaps out of fear (did i mention the size of this lady?

Incidently she is suffering from ulcer presently, SHe has passed 6 kidney stones, they found a breast lump in left breast (and did no follow up testing as of yet which is wierd) and fractured her left elbow last year.

SHe has NO insurance, so she is a bit cool to seeking out imaging. I've made it clear that without improvement and especially with worsening imaging should be considered.

I'm in agreement with Ted still that this has something to do with the pec at least until imaging is done.

ANyone else????????????????

ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211

Re: [OregonDCs] Pectoral Pain

ph,

's right about r/o Marfan's, but it still sounds like a pect strain to me.

Ted

On Fri, 1 Jun 2007 12:42:55 -0700 "Dr. ph Medlin D.C." <deadmed@...> writes:

Hi folks,

34 year old female 6'5" former water polo player complains of knife like sharp pain in upper right pectoralis region near it's attatchment to humerus and in area of inferior clavicle. SHe is large breasted (very large). Has "episodes" of debiliating pain in the region and then it subsides. Worsened by lying down supine.Pain is reproduced (even if asymptomatic) by probing the area with even light palpation. It makes her jump. At first i thought ribs, then damaged pec attatchments or clavicle displacement. Treatment of these has produced no relief as of yet (soft tissue work, rib adjusting, pectoral stretching, ice, heat) I have no films of the area, which may be a good idea at some point, but this has been going on for a while. Theres no radicular pain. I'm baffled.

ANyone see something like this before???

ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211

[Guest guest]

I attended the pain management portion of the WSCC NW

Symposium where Dr. Charlie Novak described the

following phenomenon:

When a patient has had chronic pain it triggers the

DNA to code for an increased perception of pain. I do

not remember by what mechanism from the top of my head

but included an increased receptive field. With this

patient's history it might be possible that her CNS in

now wired to perceive pain from a non-noxious

stimulus.

Good luck,

Schacker

Circle Healthcare Clinic

PDX, OR

--- deadmed <deadmed@...> wrote:

> Thanks for all the responses folks. Marfans wasnt

> considered because she is a large woman, voloptuous

> shall we say, and her father is 7 feet and two

> sisters above 6'2 " No history of it just big folks.

> Cardiac involvement was not considered simply

> because of location (right sided) and symptoms.

> there is no symptoms with exertion etc. only with

> light probing or when it flares up and proffers

> knife like sensations in the area. I've been

> treating her for a variety of things, but I've

> treated this particular problem for approx, 4-5

> treatments. SHe'll need more I know.

>

> Bicipital tendonitis was ruled out via ortho testing

> etc. Again, this is something that even with VERY

> light touch (surface palpation) can send her through

> the roof. However, I've noticed that she is a bit

> sensative in that way to many " sore " spots that are

> located. As a matter of fact, the left side is also

> a bit sensative in same areas, but not to the degree

> it is on the right, so large breasts may still be

> causing problems. I have not discussed breast

> reduction as of yet, perhaps out of fear (did i

> mention the size of this lady?

>

> Incidently she is suffering from ulcer presently,

> SHe has passed 6 kidney stones, they found a breast

> lump in left breast (and did no follow up testing as

> of yet which is wierd) and fractured her left elbow

> last year.

>

>

> SHe has NO insurance, so she is a bit cool to

> seeking out imaging. I've made it clear that without

> improvement and especially with worsening imaging

> should be considered.

>

> I'm in agreement with Ted still that this has

> something to do with the pec at least until imaging

> is done.

>

> ANyone else????????????????

>

>

> ph Medlin, DC

> Spine Tree Chiropractic

> 1627 NE Alberta St.

> Portland, OR 97211

> Re: [OregonDCs] Pectoral Pain

>

>

> ph,

> 's right about r/o Marfan's, but it still

> sounds like a pect strain to me.

> Ted

>

> On Fri, 1 Jun 2007 12:42:55 -0700 " Dr. ph

> Medlin D.C. " <deadmed@...> writes:

> Hi folks,

> 34 year old female 6'5 " former water polo player

> complains of knife like sharp pain in upper right

> pectoralis region near it's attatchment to humerus

> and in area of inferior clavicle. SHe is large

> breasted (very large). Has " episodes " of debiliating

> pain in the region and then it subsides. Worsened by

> lying down supine.Pain is reproduced (even if

> asymptomatic) by probing the area with even light

> palpation. It makes her jump. At first i thought

> ribs, then damaged pec attatchments or clavicle

> displacement. Treatment of these has produced no

> relief as of yet (soft tissue work, rib adjusting,

> pectoral stretching, ice, heat) I have no films of

> the area, which may be a good idea at some point,

> but this has been going on for a while. Theres no

> radicular pain. I'm baffled.

>

> ANyone see something like this before???

>

>

> ph Medlin, DC

> Spine Tree Chiropractic

> 1627 NE Alberta St.

> Portland, OR 97211

>

>

________________________________________________________________________________\

____

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[Guest guest]

Indeed. I also thought she may have had some of this going on. I too cannot

remember this process. I thought it related to plasticity or something where

a chronic injury begins to develope it's " own " neurology, but I cannot

remember it all.

thanks for your response.

ph Medlin, DC

Spine Tree Chiropractic

1627 NE Alberta St.

Portland, OR 97211

Re: [OregonDCs] Pectoral Pain

>>

>>

>> ph,

>> 's right about r/o Marfan's, but it still

>> sounds like a pect strain to me.

>> Ted

>>

>> On Fri, 1 Jun 2007 12:42:55 -0700 " Dr. ph

>> Medlin D.C. " <deadmed@...> writes:

>> Hi folks,

>> 34 year old female 6'5 " former water polo player

>> complains of knife like sharp pain in upper right

>> pectoralis region near it's attatchment to humerus

>> and in area of inferior clavicle. SHe is large

>> breasted (very large). Has " episodes " of debiliating

>> pain in the region and then it subsides. Worsened by

>> lying down supine.Pain is reproduced (even if

>> asymptomatic) by probing the area with even light

>> palpation. It makes her jump. At first i thought

>> ribs, then damaged pec attatchments or clavicle

>> displacement. Treatment of these has produced no

>> relief as of yet (soft tissue work, rib adjusting,

>> pectoral stretching, ice, heat) I have no films of

>> the area, which may be a good idea at some point,

>> but this has been going on for a while. Theres no

>> radicular pain. I'm baffled.

>>

>> ANyone see something like this before???

>>

>>

>> ph Medlin, DC

>> Spine Tree Chiropractic

>> 1627 NE Alberta St.

>> Portland, OR 97211

>>

>>

>

>

>

>

>

________________________________________________________________________________\

____

> Take the Internet to Go: Go puts the Internet in your pocket: mail,

> news, photos & more.

> http://mobile./go?refer=1GNXIC

>

[Guest guest]

Hi Joe,The increased pain sensitivity and increased area of pain sensitivity are both suggestive of a centralization problem, perhaps from chronic and unresolved pectoral and anterior cervical hypertonicities.   {That all needs to be found and worked out.  I would suggest micro-current running through the ungloved treating hand (active pad on back of hand), through the tonicity, into the passive pad under the work area.  Second channels of micro-current can penetrate injury area in various vectors during treatment.  With a pad on the back of the open treating hand, each finger when applied with firmness, becomes a point-source for the current.  Progress should be seen quickly; if not, more invasive viewing of that lump might be considered.} But the centralization might be from the left elbow; who knows?  Probe that left injury site well and try to get a sense of consequences.Her ongoing ulcer, kidney stones, and lump in breast mystery suggest hyper-sympathetonia.  Training in deep relaxation in aligned resting postures and breath physiology and consciousness, is an inexpensive way to get feet back on solid ground and the body working with, rather than against itself.  Classes are Wednesdays (5:45-6:45p) and Fridays (11-12 noon).  Have her call to arrange as class size is limited. Sears, DCNW PDX On Jun 4, 2007, at 8:55 AM, deadmed wrote:Thanks for all the responses folks.  Marfans wasnt considered because she is a large woman, voloptuous shall we say, and her father is 7 feet and two sisters above 6'2" No history of it just big folks. Cardiac involvement was not considered simply because of location (right sided) and symptoms. there is no symptoms with exertion etc. only with light probing or when it flares up and proffers knife like sensations in the area. I've been treating her for a variety of things, but I've treated this particular problem for approx, 4-5 treatments. SHe'll need more I know. Bicipital tendonitis was ruled out via ortho testing etc. Again, this is something that even with VERY light touch (surface palpation) can send her through the roof. However, I've noticed that she is a bit sensative in that way to many "sore" spots that are located.  As a matter of fact, the left side is also a bit sensative in same areas, but not to the degree it is on the right, so large breasts may still be causing problems. I have not discussed breast reduction as of yet, perhaps out of fear (did i mention the size of this lady?   Incidently she is suffering from ulcer presently, SHe has passed 6 kidney stones, they found a breast lump in left breast (and did no follow up testing as of yet which is wierd) and fractured her left elbow last year.  SHe has NO insurance, so she is a bit cool to seeking out imaging. I've made it clear that without improvement and especially with worsening imaging should be considered. I'm in agreement with Ted still that this has something to do with the pec at least until imaging is done. ANyone else????????????????  ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211 Re: [OregonDCs] Pectoral Painph,'s right about r/o Marfan's, but it still sounds like a pect strain to me.Ted  On Fri, 1 Jun 2007 12:42:55 -0700 "Dr. ph Medlin D.C." <deadmednetzero (DOT) net> writes:Hi folks,34 year old female 6'5" former water polo player complains of knife like sharp pain in upper right pectoralis region near it's attatchment to humerus and in area of inferior clavicle. SHe is large breasted (very large). Has "episodes" of debiliating pain in the region and then it subsides. Worsened by lying down supine.Pain is reproduced (even if asymptomatic) by probing the area with even light palpation. It makes her jump. At first i thought ribs, then damaged pec attatchments or clavicle displacement. Treatment of these has produced no relief as of yet (soft tissue work, rib adjusting, pectoral stretching, ice, heat)  I have no films of the area, which may be a good idea at some point, but this has been going on for a while. Theres no radicular pain. I'm baffled. ANyone see something like this before???  ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211 

[Guest guest]

The only other thoughts I have after reading this thread are;

1- if she is exquisitely tender on specific spots, you might try

counter-strain (positional release) (fold and hold)-

in other words, for extremely tender points, sometimes shortening them

is the best way to quiet down the pain.

The only other thought I have is to check the sub-clavius muscle. Best

way to get to this, is to have pt supine, and lift the involved shoulder

up, via an SOT block or something similar, which relaxes the subclavian

area and allows access.

good l uck, puzzling case

Marc

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

deadmed wrote:

>

> Thanks for all the responses folks. Marfans wasnt considered because

> she is a large woman, voloptuous shall we say, and her father is 7

> feet and two sisters above 6'2 " No history of it just big folks.

> Cardiac involvement was not considered simply because of location

> (right sided) and symptoms. there is no symptoms with exertion etc.

> only with light probing or when it flares up and proffers knife like

> sensations in the area. I've been treating her for a variety of

> things, but I've treated this particular problem for approx, 4-5

> treatments. SHe'll need more I know.

>

> Bicipital tendonitis was ruled out via ortho testing etc. Again, this

> is something that even with VERY light touch (surface palpation) can

> send her through the roof. However, I've noticed that she is a bit

> sensative in that way to many " sore " spots that are located. As a

> matter of fact, the left side is also a bit sensative in same areas,

> but not to the degree it is on the right, so large breasts may still

> be causing problems. I have not discussed breast reduction as of yet,

> perhaps out of fear (did i mention the size of this lady?

>

> Incidently she is suffering from ulcer presently, SHe has passed 6

> kidney stones, they found a breast lump in left breast (and did no

> follow up testing as of yet which is wierd) and fractured her left

> elbow last year.

>

>

> SHe has NO insurance, so she is a bit cool to seeking out imaging.

> I've made it clear that without improvement and especially with

> worsening imaging should be considered.

>

> I'm in agreement with Ted still that this has something to do with the

> pec at least until imaging is done.

>

> ANyone else????????????????

>

>

> ph Medlin, DC

> Spine Tree Chiropractic

> 1627 NE Alberta St.

> Portland, OR 97211

>

> * Re: [OregonDCs] Pectoral Pain

>

> ph,

> 's right about r/o Marfan's, but it still sounds like a pect

> strain to me.

> Ted

>

> On Fri, 1 Jun 2007 12:42:55 -0700 " Dr. ph Medlin D.C. "

> <deadmed@... <mailto:deadmed@...>> writes:

>

> Hi folks,

> 34 year old female 6'5 " former water polo player complains of

> knife like sharp pain in upper right pectoralis region near

> it's attatchment to humerus and in area of inferior clavicle.

> SHe is large breasted (very large). Has " episodes " of

> debiliating pain in the region and then it subsides. Worsened

> by lying down supine.Pain is reproduced (even if asymptomatic)

> by probing the area with even light palpation. It makes her

> jump. At first i thought ribs, then damaged pec attatchments

> or clavicle displacement. Treatment of these has produced no

> relief as of yet (soft tissue work, rib adjusting, pectoral

> stretching, ice, heat) I have no films of the area, which may

> be a good idea at some point, but this has been going on for a

> while. Theres no radicular pain. I'm baffled.

>

> ANyone see something like this before???

>

>

> ph Medlin, DC

> Spine Tree Chiropractic

> 1627 NE Alberta St.

> Portland, OR 97211

>

>

>