Pericardium-Focused Osteopathic Treatment in Chronic Cervicothoracic Pain Following Median Sternotomy for Cardiac Surgery

Chronic cervicothoracic pain may develop following median sternotomy, with an underlying pathophysiology that remains incompletely elucidated. Pericardial fascial restriction and mediastinal adhesions have been proposed as potential contributors to the onset and persistence of symptoms. We report the case of a 72-year-old man with a history of triple coronary artery bypass grafting who presented with chronic cervicothoracic pain and restricted cervical rotation. An osteopathic manipulative treatment (OMT) protocol focused exclusively on the pericardium was applied, comprising four sustained-tension techniques delivered across three sessions. Pre- and post-intervention assessments were conducted at each session, in addition to a final evaluation 15 days after the last session (day 35) and a further telephone follow-up 32 days later (day 67), without objective reassessment at this final contact. Objective improvements were observed in cervical rotation measured using digital inclinometry (right/left: 34°/38° to 54°/55°) and in pressure pain threshold assessed by algometry over C7 (1.2-2.8 kg/cm2), together with a reduction in pain intensity, as measured by the numeric pain rating scale (NPRS), from 7 to 2. No adverse events were reported. Although these findings should be interpreted with caution, given the single-case design, they suggest that a pericardial-focused approach may be associated with clinically meaningful improvements in cervical mobility and chronic post-sternotomy cervicothoracic pain. Controlled studies with larger sample sizes, standardised outcome measures, and assessor blinding are required to evaluate its efficacy and to further elucidate the underlying neurophysiological mechanisms involved.