Prall Joshua, Dunning James, Young Ian, Ross Michael, Escaloni James, Bliton Paul
American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, 445 Dexter Avenue, Suite 4050, Montgomery, AL 36104, USA.
Montgomery Osteopractic Physical Therapy & Acupuncture, Montgomery, AL 36104, USA.
Healthcare (Basel). 2025 Jun 6;13(12):1355. doi: 10.3390/healthcare13121355.
Spinal thrust manipulation has been found useful for improving pain and mobility in musculoskeletal conditions of the thoracic spine. This case report highlights the importance of incorporating high-velocity low-amplitude (HVLA) thrust manipulation to the mid-thoracic rib articulations in a patient experiencing thoracic spine pain associated with an acute onset of osteomyelitis at levels T7-T9. A 49-year-old female who was recovering from osteomyelitis of the thoracic spine 4 months prior was referred to physical therapy by her neurosurgeon. Her osteomyelitis infection resulted in a bone-on-bone interaction between T7 and T9, resulting in significant thoracic spine pain. Severe restrictions in active range of motion (AROM) were found in extension and right and left rotation. At initial evaluation, the patient's pain intensity score was 8/10 (NPRS, 0-10), the disability score was 46/50 (NDI, 0-50), and the patient-specific functional scale score was 3/10 (PSFS, 0-10). Initially, interventions included grades I-IV posterior to anterior (PA) mobilizations of the thoracic spine from levels T2 to T9, mobilization with movement of the thoracic spine for extension and rotation bilaterally, scapular stabilization, and thoracic mobility exercises. Treatment progressed to HVLA thrust manipulation techniques targeting the costotransverse articulations of ribs 2-9. Following the initial eight treatment sessions over 4 weeks, minimal improvement was observed for pain (NPRS from 8/10 to 6/10), disability (NDI from 46/50 to 34/50), and thoracic extension AROM (13°). However, during visits 9-16, the addition of HVLA thrust manipulation targeting the costotransverse articulations resulted in significant improvements in pain, disability, and AROM. The patient was subsequently discharged after 16 visits and able to return to a full workday as a teacher without any thoracic pain or ROM restrictions. At the 6-month follow-up, the patient outcomes remained, and she was working with no restrictions. The addition of HVLA thrust manipulation targeting the mid-thoracic rib articulations to a program of non-thrust mobilization and exercise appeared useful for improving pain, disability, and range of motion in a patient recovering from osteomyelitis of the thoracic spine.
脊柱推力整复已被证明对改善胸椎肌肉骨骼疾病的疼痛和活动能力有用。本病例报告强调了在一名患有T7 - T9节段急性骨髓炎并伴有胸椎疼痛的患者中，对胸中段肋骨关节进行高速低幅（HVLA）推力整复的重要性。一名49岁女性，4个月前正在从胸椎骨髓炎中康复，她的神经外科医生将其转诊至物理治疗。她的骨髓炎感染导致T7和T9之间出现骨对骨的相互作用，从而引起严重的胸椎疼痛。在伸展以及左右旋转时，主动活动范围（AROM）出现严重受限。在初始评估时，患者的疼痛强度评分为8/10（数字疼痛评分量表，0 - 10），残疾评分为46/50（颈部残疾指数，0 - 50），患者特定功能量表评分为3/10（患者特定功能量表，0 - 10）。最初的干预措施包括对T2至T9节段的胸椎进行I - IV级的由后向前（PA）松动术、双侧胸椎伸展和旋转的运动中松动术、肩胛骨稳定训练以及胸椎活动度练习。治疗进展到针对第2 - 9肋肋横突关节的HVLA推力整复技术。在4周内进行了最初的8次治疗后，疼痛（数字疼痛评分量表从8/10降至6/10）、残疾（颈部残疾指数从46/50降至34/50）和胸椎伸展AROM（13°）的改善甚微。然而，在第9 - 16次就诊期间，增加针对肋横突关节的HVLA推力整复导致疼痛、残疾和AROM有显著改善。该患者在16次就诊后随后出院，能够作为一名教师重返全天工作，且没有任何胸椎疼痛或活动范围受限的情况。在6个月的随访中患者的治疗效果得以维持，她工作时没有任何限制。在非推力松动术和运动方案中增加针对胸中段肋骨关节的HVLA推力整复，似乎有助于改善一名正在从胸椎骨髓炎康复的患者的疼痛、残疾和活动范围。
