Chest Pain In A 22 Year Old Lacrosse Player - Page #1

Author: Curtis Andrews, DO
Co Author #1: Pierre Rouzier, MD. UMASS Amherst.

Patient Presentation:
22 year old, healthy men's lacrosse player suffered a high energy collision during scrimmage. While running at full speed the patient and a defender collided with the defender's shoulder impacting the chest of the patient. He reported feeling immediate central chest and left anterior neck pain and briefly having the wind knocked out of him. He noted swelling over the left parasternal area within minutes of the injury. He was evaluated by the athletic trainer on the sideline and sent to the emergency room for further evaluation.

healthy male, no significant past medical history

Physical Exam:
Vitals: afebrile, pulse 92, respirations 16, blood pressure 116/72
HEENT: pupils equal, round, reactive to light and accommodation. Extra ocular movements intact. oropharynx/ dentition normal.
NECK: symmetric, no deformity or mass. trachea midline. no tenderness to palpation, full active and passive range of motion.
CV: regular rhythm, normal S1 and S2. extremity pulses normal.
RESP: clear lung sounds throughout
CHEST: 13x8 cm soft tissue swelling over the superior, left parasternal region. tenderness to palpation of the left sternoclavicular joint. sternum and clavicle otherwise nontender
Extremities: no clavicular deformity. acromioclavicular joints symmetric. left shoulder range of motion decreased due to pain referred to sternum.
NEURO: no focal sensory or strength deficits of cranial nerves or of upper and lower extremities.

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