Author: Bryan Hess, DO
Co Author #1: Dr. Sara Neal, MD
Co Author #2: Dr. Karl B. Fields, MD
Co Author #3: Dr. T. Ryan Draper, DO
Editor: Peter MacArthur, MD
An 18 year old male was evaluated during pre-participation physicals for football.
During pre-participation physicals for freshman athletes at a local college, an 18 year old freshman football defensive back was examined. He had a severe right unilateral chest wall deformity with asymmetry. He also had evidence of correction of a brachysyndactyly of the right hand. Otherwise, the patient was a healthy male with no significant past medical history. He denied any previous injury to the chest, surgical treatment to his chest, or pain/weakness to the right side.
The patient was well-appearing and in no acute distress. Inspection revealed symmetric bilateral shoulder muscle bulk and tone. His shoulder exam was grossly normal without deficits in range of motion or strength. There were no scars or ecchymoses. His chest wall showed obvious muscular atrophy/defect on the right side Case Photo #1. There were no palpable rib abnormalities anteriorly. His back exam was normal without deformity or scoliosis. Measurement from the greater tuberosity of the humerus to the ulnar styloid was 54cm bilaterally. His right hand was smaller than his left with scarring on the palmar surface Case Photo #2. His grip strength was equal bilaterally. His feet were normal and symmetric. His cardiac exam revealed a regular rate and rhythm with no murmurs and a normal S1 and S2. His point of maximum impulse was normal Case Photo #3.
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