Author: Amy Kreykes, MD
Co Author #1: Andrea Aagesen, DO
University of Michigan Physical Medicine and Rehabilitation
Editor: Michael Fong, MD
19-year-old female collegiate crew athlete presents to a Physical Medicine and Rehabilitation sports medicine clinic in December with six weeks of left sided thoracic back pain. It began abruptly when pulling backwards while rowing starboard. Pain is located in her thoracic region, sharp, and non-radiating. The first two weeks after the injury her pain intensity made it difficult to breathe. Now her pain is a 6/10. She has no weakness, numbness, tingling, or bowel/bladder difficulty. Her pain increases with yawning or sneezing, and rowing, but not with bowel movements. Naproxen allowed her to breathe more easily but was ineffective for pain so it was discontinued. Prior diagnostic evaluation includes an X-Ray of her ribs and three phase bone scan, both of which were unremarkable for rib pathology. There is no significant past medical, surgical, or family history.
Unremarkable vital signs. Breathing unlabored. Skin without rashes. There is diffuse tenderness over left sided ribs posteriorly but not over cervical or thoracic spine. Left sided dysfunction in ribs 4-6 and 8-12. Normal thoracic spine range of motion. Active left shoulder flexion and abduction limited by rib pain, but full passive range of motion. No scapular winging. Upper and lower extremity strength is full. Sensation to light touch is intact in upper extremities and thoracic region. Reflexes 2+ and symmetrical at biceps, triceps, brachioradialis. Normal gait including heel, toe, and tandem walking.
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