OMT as an Effective Treatment for Patients with Long-Term Postoperative Complications: A Case Study

Background: Prior studies have shown how Osteopathic Manipulative Treatment (OMT) performed on patients with non-emergent, undifferentiated chest pain can offer relief as a supplement to allopathic medicine. Previous surgery or trauma to the chest, abdominal, or pelvic regions commonly produces somatic dysfunction which can worsen existing cardiovascular conditions. However, little information exists regarding the effect of OMT in the long-term postoperative recovery of these patients. In 2021, medical students at a mobile clinic in Sanderson, TX provided healthcare screenings and OMT to patients in underserved rural communities. Case Information: A 71-year-old Caucasian female presented to the clinic with 1 week of dyspnea and chest heaviness, worsening within 24 hours prior to her visit. The patient reported progressive epigastric pain that radiated upwards, generalized myalgia, bilateral lower extremity paresthesias, and decreased urination. Her past medical history was significant for coronary artery disease, hypertension, GERD, chronic kidney infections, sinus infections, dural hematoma, hypothyroidism, osteoarthritis, and nose carcinoma. She has a history of two previous stent placements in 2019, a dural hematoma surgery in 2021, a tonsillectomy, and a tubal ligation. Current medication use included baby aspirin, lisinopril, metoprolol, levothyroxine, rosuvastatin, and Zyrtec. The epigastric pain did not improve with pain medications. On admission, vital signs showed a HR of 61bpm, BP of 142/78, and temp of 97.8F. Physical exam revealed regular rate and rhythm without bruits, gallops, or murmurs. PMI was displaced laterally indicating possible ventricular dysfunction. Radial, Dorsalis Pedis, and posterior tibial pulses 2+ bilaterally, extremities were warm to touch. Lungs were CTA bilaterally. Additional physical exam findings include severe RUQ pain with no visible masses or abdominal distension. Gallbladder ultrasound was negative for gallstones, with some wall thickening. Cardiac ultrasound was performed which revealed ventricular and septal hypertrophy, reduced LV function by 50%, and reduced ejection fraction by 50%. Given her chest discomfort and potential causative somatic dysfunctions, an osteopathic exam was performed, and anterior thoracic tender points were found at AT3 and AT8. Rib examination revealed a significant right ribs 8-10 inhalation dysfunction which was then treated with OMT, specifically Muscle Energy. The patient had immediate relief of symptoms after the treatment and reported nearly complete resolution of her pain. Conclusions: This report illustrates the use of OMT to beneficially alleviate symptoms of dyspnea and severe epigastric pain in a patient with a history of coronary artery disease and multiple invasive surgeries, including coronary revascularization. Somatic dysfunction of the thoracic cage can significantly worsen existing cardiac symptoms and present very similarly to acute myocardial infarction. This case suggests that OMT should be considered in the management of future patients who are experiencing complications in the years following their surgery to improve patient outcomes.