I had a pt sent to me by a PM&R doc. Wants me to DN and cupping for chest wall pain. Pt had CABG in April 2019 and continues to have pain in L pecs lateral to sternum. Very tender to palpation.No pain at incision. Cleared by cardiologist. Pt bends forward to relieve pain. I know I can do the 25 to 50 mm laterally at the Lat Pec homeostatic point. Any other thoughts, suggestions, advice? Needle size, angle?
I really love cupping over these areas. If palpation / compression is noxious give it distraction. This is most likely residual irritation of the anterior emergent point of the anterior primary rami. I would assess the lateral emergent point as well near the mid axillary line. Cupping or gentle skin stretching at this area should work well in these thinner areas.
For needling, I would trace back and needle the associated thoracic paravertebral level (posterior primary rami).