Post-sternotomy pain syndrome following cardiac surgery: case report

Abstract

Over 2 million people undergo sternotomy worldwide for heart surgery each year, and many develop post-sternotomy pain syndrome (PSPS) which persists in the anterior thorax. In some patients, PSPS lasts for many years or suddenly reappears a long time after the sternotomy. The exact etiology of PSPS is unknown. This article presents a case report of a patient with a diagnosis of PSPS (after cardiac surgery 4 years prior) for whom an osteopathic approach was used, which successfully eliminated the pain. In a previous study, we demonstrated that this osteopathic procedure could reduce sternal pain associated with a recent surgical wound. Further efforts are needed to understand the reasons for PSPS. In light of new scientific data, these osteopathic techniques could contribute to a multidisciplinary approach to solve the problem.

Lymphatic Pump Manipulation in Patients with Chronic Obstructive Pulmonary Disease

“…In our department, we do not perform AMLPM on patients with COPD. Instead, we recommend approaches which are gentle and of osteopathic derivation, osteopathic manipulative treatment (OMT), which have already been clinically tested for pain reduction, are without side effects, and achieve precocious clinical stability [48][49]. The goal is to improve the flow of the lymph and thus provide space to the tissues; our aim is not to increase the number of lymphocytes.…”

“…Our approach is standardized and with the patient seated; the operator remains behind the patient. The first approach is for the thoracic outlet: "The operator stands behind the patient, resting his/her hands on the thoracic outlet, with the index and middle fingers on the clavicle and the thumbs up to cervical-7 (C7), facing each other, while the ring finger and little finger are placed on the anterior area of the chest" [48]. We approach the thoracic strait because it is an important area in which the venous and lymphatic systems connect.…”

“…We approach the thoracic strait because it is an important area in which the venous and lymphatic systems connect. The second phase concerns the mediastinal area: "In the second phase, the operator places one hand on the anterior area of the sternum, while the other hand is parallel on the patient's back" [48]. By reducing the mediastinal musculoskeletal tension, one should positively affect the movement of the viscera inside the ribcage.…”

“…By reducing the mediastinal musculoskeletal tension, one should positively affect the movement of the viscera inside the ribcage. The third and last phase is for the diaphragm muscle: "involve the operator's hands being placed on the anterolateral area on the costal diaphragm" [48]. By giving the diaphragm the possibility of encountering less costal resistance, our technique should improve its excursion capacity and favor the natural respiratory lymphatic pump.…”

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 2

“…Other diaphragms are not considered, such as the sole of the foot or the posterior area of the knee or other body portions reminiscent of a diaphragm, because the five diaphragms are vital for survival; without the limbs, a person can live but, without the five diaphragms, a person risks death. Not surprisingly, working with this orientation can make a difference in the patient's clinical picture [5][6][7][8][9]. The article reviews the anatomy of the anterolateral myofascial relationships of the five diaphragms, continuing and concluding the path of the first part of the previous article.…”