The Fascial Manipulation Method is a cycle of articles dedicated to the understanding of themost common dysfunctions we meet during our clinical practice, specifically theirmanifestation and treatment with Fascial Manipulation. FM specialists report clinical cases,accurately describing their symptomatology, the chosen work plan and the resultsobtained, thanks to the treatment. For privacy reasons, the names of the patients have been changed.
Clinician: Di Mauro Rossana
A patient visited on March 1, 2023 to start the rehabilitation program for her right upper limb, following a humeral fracture due to an accidental fall on December 7, 2022. The fracture was initially treated conservatively with an upper limb brace. The patient subsequently underwent osteosynthesis surgery with plates and screws on December 11, 2022.
The brace was removed on January 26, 2023, but the patient waited until March 1, 2023 to begin physiotherapy.
HYPOTHESIS
During the first physiotherapy evaluation, anamnestic data were collected from which it emerged that in 2004 she underwent a left mastectomy with removal of the axillary lymph nodes and that in 2019 she had a right femoral fracture, surgically treated with an intramedullary nail.
Upon inspection of the right upper limb, it was noted that the scar in the anterior region of the shoulder was very red, the skin of the arm was dry, and the entire limb was edematous.
MOVEMENT VERIFICATION
The patient complained of a feeling of heaviness in the right upper limb and pain localized in the anterior part of the arm, near the scar. The pain increased when performing the movement verification, particularly in the movements of anterior flexion of the arm at 80°, in abduction at 45° and in external rotation. In addition, for two months she had been complaining of lateral pain in the neck on the right side, which worsened with right lateral inclination.
PALPATORY VERIFICATION
During the palpatory verification, it emerged that in the area proximal to the scar there was a skin hypersensitivity, with slightly enlarged axillary lymph nodes and poor mobility of the superficial fascia in the cubital region.
TREATMENT
The treatment performed was directed at the superficial fascia for the lymphatic system as the patient had a reduction in skin mobility, edema, dry skin, slightly swollen lymph nodes and hypersensitivity near the scar. The points and quadrants treated were the following: lymph nodes in the right CL quadrant, right AN LA – TH 2, right AN LA HU, right AN LA CU
RESULTS
After 2 treatments aimed at the superficial fascia the patient felt a reduction in edema and the feeling of heaviness and greater fluidity in the movements of the upper limb and neck.