title: Differential diagnosis and treatment in a patient with posterior upper thoracic pain.
abstract: OBJECTIVE
  Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain.
  
  
  METHODS
  The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises.
  
  
  RESULTS
  The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities.
  
  
  CONCLUSIONS
  This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.
authors.affiliation: Krannert School of Physical Therapy, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227-3697, USA. fruths@uindy.edu
authors.forename: Stacie J
authors.initials: SJ
authors.lastname: Fruth
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001416:Back Pain / Q000209:etiology*; D002637:Chest Pain / Q000209:etiology*; D003663:Decision Trees; D003937:Diagnosis, Differential; D005081:Exercise Therapy / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation; D008297:Male; D008487:Medical History Taking; D009209:Myofascial Pain Syndromes / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods*; D011187:Posture; D016059:Range of Motion, Articular; D012272:Ribs; D012677:Sensation; D013904:Thoracic Vertebrae