Clinical Scenario or Case: A postpartum breastfeeding mother presented with acute right-sided chest and shoulder pain. Her obstetrician referred her to the emergency department due to concern for possible myocardial infarction. She underwent a full cardiac workup, including ECG, chest imaging, stress testing, and cardiac catheterization—all of which were unremarkable. Despite the negative findings, her debilitating pain persisted without a definitive diagnosis.
Evidence/Literature Review: Musculoskeletal pain affects over 90% of postpartum breastfeeding women (Prasanna & Tamizhmani, 2018). Rib somatic dysfunction is a common finding in osteopathic clinics but remains underrecognized in standard postpartum care (Baltazar et al., 2020). Emergency settings typically prioritize cardiac causes, yet many patients ultimately discharge with a musculoskeletal diagnosis following inconclusive workups (Clapp et al., 2023).
Unique Aspects of Case: After an inconclusive cardiac workup, the patient was evaluated by an osteopathic physician. Structural examination revealed somatic dysfunction of the right first rib, likely resulting from postural strain during breastfeeding. The dysfunction was treated using the Still Technique, followed by gentle OMT to restore rib motion. The patient experienced immediate and sustained relief of her chest and shoulder pain. This case underscores the value of osteopathic structural diagnosis in uncovering biomechanical causes of postpartum symptoms.
Recommendations/Conclusions: This case highlights the value of osteopathic diagnosis and hands-on structural examination when conventional diagnostics fail to identify the source of pain. It reinforces foundational osteopathic principles—that the body is a unit, and structure and function are reciprocally related—and demonstrates their relevance in emergency evaluations of postpartum patients. The resolution of cardiac-like symptoms through correction of a first rib dysfunction emphasizes the clinical importance of addressing structural strain. Additionally, this case calls for greater awareness of musculoskeletal complications related to breastfeeding posture, which may mimic serious pathology but are effectively treatable with OMT.
