Filip Dudal D.O.
Maidstone, Kent, G.B.
Still Osteopathic Clinics - Bergamo

Fracture of the left clavicle, fracture of the C6-C7 cervical spine, Trauma of the left shoulder leading to peripheral neurogenous pain of the left brachial plexus.

Sutherland Technique Method, Functional Technique, Articular Thrust Technique, Muscular chains, Muscle Energy Technique, General Osteopathic Treatment, Sacro Occipital Technique.

Total recovery of cervical and cervical-dorsal mobility. Total absence of pain. Posture corrected. Incomplete recovery of the function of the upper left arm.

The method employed makes it possible to reduce the period of immobility and to accelerate recovery of correct static and dynamic states.

Introduction
T.G.born on 24-02-59 was involved in a road accident on 03-07-2001. He suffered a cervical trauma, a trauma of the left shoulder and a cranio-facial trauma. He came to our clinic wearing a cervical collar with a chin-occipital support on 02-10-2001, that is 3 months after suffering the trauma. (photo 1a, photo 1b, photo 2, photo 3)

Material
X-ray of 03-07-2001: multiple-fragment comminuted fracture of the left clavicle (photo 4)
X-ray of 05-07-2001: left clavicular osteosynthesis with Kirschner wire (photo 5)
X-ray of 05-07-2001: loss of normal anterior-posterior rapport between C6-C7. (photo 6)
CAT of 06-07-2001: fracture of the lower right articular process of C6. Fracture of the right lamina of C6. (photo 7)
Doppler of 25-07-2001: slightly reduced flow of the left vertebral artery.
NMR of 20-08-2001: fracture of the right transverse process of C7 extending to the transverse foramen and also involving the upper articular facet (photo 8)
EMG: This report indicates a marked peripheral neurogenous suffering with signs of denervation in the left suprascapular and axillary inervation zone, associated with slight suffering of the motor fibres in all the examined areas of the left brachial plexus. Suspected paresis of the left circumflex nerve.
Posture: A significant increase in tone of the Anterior-Median Chain and the Anterior-Posterior Chain (photo 3). The forward projection and flexure of the head are typical of this increased tone. The lateral deviation is in category II RUMPS (S.O.T.) (photo 1b).
Mobility: Cervical mobility reduced in all directions. Complete absence of abduction of the left arm. Loss of muscular mass in the suprascapular and deltoid areas. Reduced muscular mass of the upper left trapezium.

Methods
Sutherland technique, Functional technique, for the median and deep cervical fasciae of the triangular muscle of the sternum and diaphragm. Muscular chains of the scalene and longus colli muscle group. Articular Thrust Technique for C1, C3, and D6. General Osteopathic Treatment (GOT). Muscle Energy Technique for the clavicle. Muscle Energy Technique Isometric musculation of the muscular cavities corresponding to the neurological pain.

Results
Full recovery of articular mobility of the cervical rachis and the clavicle. Recovery of passive mobility of the left glenoid-humeral articulation. Posture corrected on the sagital and frontal axis (Photo 9). No pain. The patient is still being cured for possible recovery of motor activity of the left arm.

Discussion
The trauma prevented free flow of the vertebral arteries. The fracture of the clavicle and clavicular immobility acted on the the sub-clavicular vein and artery. The vertebral lesions of C6 and C7 acted on the autonomous nervous system affecting the heart. The left brachial plexus was seriously injured. The lymphatic vessels of the subclavicular group were compressed. The change in posture and the loss in mobility of the cervical rachis were not so much due to the structures that had yielded to the shock, i.e. to the fractures, but rather to the modified tone of the structures that had absorbed the impact, especially the fascias and muscles. The freeing of fascial and muscular tension not only enables recovery of a more harmonious posture and of physiological movement but, above all, recovery of the normal flow of liquids and free transmission of nervous impulses.

Conclusion
Although the patient suffered complex clavicular and cervical fractures, this clinical case shows that osteopathic medicine should be implemented immediately after the trauma, thus speeding up the recovery of movement, shortening the painful period, accelerating the freeing of the flow of liquids and of the nervous impulse. The immobility required to knit a fracture is no contraindication to early osteopathic treatment. As described in the articular thrust techniques, there is no risk in expert manipulation to correct lesions above and below the fracture. Only the correction of the entire reactive mechanism to the impact wave, and, therefore, not merely the joints of the fractured bones, can lead to a recovery of normal physiology.