Cervical + Clavicle Pain from increased CervicoPleural Ligament tension and poor breathing mechanics

Subjective

Mr S, 23 years old, Male, L hand dominant

Pa - deep ache over lateral neck, onsets once it reaches afternoon and pain lingers till sleep time

Pb - discomfort over lateral supraclavicular space upon shoulder elevation & protraction

MOI - nil trauma, insidious onset 3 months ago, neck pain initially on both sides, L more than R but subsequently shifted to R side only. Significant history to be noted is that patient changed his mattress around the same time, unable to determine if it was before or after onset. Prefers to sleep side lying.

Patient also reported sometimes shoulders felt like they were gonna drop off and post exercise DOMS of upper trapezius persists longer than usual ever since as well as increased sensation over R thumb and index finger occasionally.

Objective findings:
Observation - typical swayed back posture, well developed abdominals
Palpation:

• Upper Trapezius L more tone than R
• R Subclavius & Diaphargm tender on palpation
• 1st Rib depressed on R
• R CervicoPleural Ligament tight

ROM - Extension/Right Rotation/Right Lateral flexion near full, limited by pain at end range, Lower Cx and Upper Tx reduced ROM, improved with postural correction.

PAIVM - C5-T2 hypomobile (C7-T2 hypomobile++), R worse than L
SCJ - reduced depression(clavicle head didn't go down) on R with shoulder protraction, symptoms improved with manual AP glide.
No biomechanical issues with scapula elevation, no change of symptoms with AP and inferior glide during scapula elevation
ACJ - slight hypomobile on the R, no reproduction of symptoms
ScapuloThoracic Joint - no hypomobility and symptoms in all directions

Breathing - reduced upper ribs mobility
Ribs accessory:
Sternocostal Joint - 1 & 2 hypomobile
Costotransverse Joint- 1 & 2 hypomobile

Muscle Length Test
Upper Trapezius NAD
Scalenes - R worse than L, especially posterior scalenes

Treatment
MET to facilitate SCJ AP glide
//Pb ->0/10 on shoulder protraction, Pb still persist on scapula elevation
R CervicoPleural Ligament release
//Pb ->0/10 on scapula elevation
R C7/T1 manipulation
//Pa decreased and onset in extreme end range, Range increased
T1/T2 mobilisation in manip position + MWM with R Cx quadrant
//Pa -> 0/10, range increased.
Linea Albea release
//R diaphragm reduced pain on palpation.