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A Crossfitter With Chest Pain - Page #1
 

Author: Amanda Wise, DO
Co Author #1: Erek Latzka, MD, RMSK
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Ian McKeag, MD, MS

Patient Presentation:
The patient was a 32 year old female, otherwise healthy athlete who presented with a 6-month history of chest pain.

History:
The patient felt a sudden pop in her chest while doing dips at her CrossFit gym, and woke up the following day with significant, sternal chest pain. It improved after 2 months of rest, but returned after doing power cleans and heavy overhead lifting. The pain was intermittent and became more constant 2 months later. She described her initial pain as along bilateral sternal borders but localized to her left mid-sternal border with associated tenderness. Her pain worsened with deep breathing and overhead movements. She denied any other trauma to her chest. Previous workup for this included a chest x-ray, which was negative for fracture. She was treated for presumed costochondritis with physical therapy, activity modification, and a steroid taper for one week followed by one week of naproxen. Her pain quickly returned when transitioning to non-steroidal anti-inflammatories.

Physical Exam:
The patient's exam was significant for tenderness at the left sternocostal border of ribs 4-6. There was no tenderness in the pectoralis muscle. She had no pain with full active range of motion of her upper extremities. Her pain was reproduced with a resisted pushup and overhead press.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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