[Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment c6-c7: a case report]

This article presents the case of a 41-year-old female physician complaining about frequent chest pain attacks and breathing difficulties. Disorders started six months previously after inexpert manipulation of the thoracic spine performed by a physiotherapist while massaging the patient's back. Numerous diagnostic examinations (CT of the thorax, MRI of the thoracic spine, esophagography, cardiological examination, pulmological examination) did not explain the cause of subjective symptoms. Although the patient, who came to our private practice setting for examination of the spine and possible manual therapy, did not complain about disorders in the region of cervical spine, on the basis of clinical examination, we suspected the cervicogenic angina (CA; the attacks of chest pain caused by cervical radiculopathy; earlier term "cervical angina" is terminologically inappropriate). Namely, by means of clinical examination, we found very restricted active and passive mobility of the cervical spine, hyperalgic skin zones in the dermatomes C6-TH4, spasm of the cervical extensors and upper parts of the trapezius muscle, hypoesthesia in the dermatomes C6-TH1 and decreased left triceps reflex. MRI examination of the cervical spine showed left side disc herniation at the C6-C7 segment. Using manual therapy (traction mobilization of the cervical spine, segmental mobilization, distraction manipulation in full Nelson position), the complete regression of subjective symptoms was achieved which confirmed cervical origin of the pain. By analyzing anamnestic data, we concluded that the inexpert manipulation of the thoracic spine (the patient was lying in prone position), which caused strong local pain, induced sudden extension-flexion reflex movement of the cervical spine which the patient did not notice at that moment because of the acute pain in the region of the thoracic spine, resulting in herniation of already degeneratively altered disc at the C6-C7 segment with consequential CA.