Author: Tony Truong, MD
Co Author #1: Tony Truong, MD
Co Author #2: Susan M. Joy, MD
Editor: Matthew Hall, DO
Patient was referred to sports medicine from pediatrics for left-sided chest, scapular, and shoulder pain.
A 12 year-old male baseball player was referred to sports medicine from pediatrics for left-sided chest, scapular, and shoulder pain. He did not exactly remember what had happened, but 2 days prior he dove awkwardly into 2nd base, twisting his body and thought he hit the ground on his left side. He described progressively worsening pain over his chest and ribs, severe enough to disrupt sleep. He was unable to localize his pain describing it as encompassing his entire chest wall. Pain was exacerbated with deep inspiration, running, coughing, sneezing, and laughing. He denied fever, shortness of breath, dyspnea, or tachypnea. Review of systems was unremarkable. He was in 7th grade and active with baseball and hockey.
Past medical history was notable for allergic rhinitis, asthma and atopic dermatitis with normal growth and development. He had undergone prior tonsillectomy and turbinate coblation.
Medications included albuterol, budesonide inhalation, singulair, cetirizine and nasal sprays. No drug allergies were reported. He lived at home with his mother and younger sister.
Vitals: Blood pressure: 93/63, pulse: 74, height 5' 1", weight 105 lbs.
General: Well appearing male in no apparent distress
Neck: Supple, no adenopathy or masses.
Chest: There was some prominence of the lower ribs observed on the left compared to the right but no frank deformity. Pain was reproduced over the entire left chest wall with direct palpation and compression.
Cardiovascular: Regular rate and rhythm without murmurs or clicks.
Lung: Clear to auscultation bilaterally.
Abdomen: Soft with diffuse tenderness in the left upper quadrant without hepatomegaly or a palpable splenic tip
Back: No tenderness along the spine with normal range of motion.
Extremities: Unremarkable. No clubbing, cyanosis, or edema.
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