Chest Pain: Not A Typical Day At The Pool

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Chest Pain: Not A Typical Day At The Pool - Page #1

Author: Tyler Wilson Co Author #1: Michael O'Neal, DO Senior Editor: Justin Mark Young, MD Editor: Alan Shahtaji, DO Patient Presentation: A 23-year-old male American football player (wide receiver) presented with vague left upper anterior chest wall pain. History: There was no blunt trauma associated with onset of symptoms. The patient thought the pain was originating from his clavicle. Pain was worse with overhead movements, which made it difficult to catch balls above his head. He was treated empirically for an unspecified "strain" injury, including weekly pre-game lidocaine injections into the area of the costosternal articulation and sternoclavicular joint. No diagnostics were performed. Although he was able to effectively participate in games due to the analgesia injections, the pain persisted and gradually worsened during the season. He ultimately developed anterior and lateral left-side neck pain. He used oral anti-inflammatories with mild, temporary relief but nothing provided resolution. Physical Exam: Physical examination revealed tenderness inferior to the sternoclavicular joint in the area of the costo-manubrial junction. There was no tenderness over the AC joint or coracoid process, no chest wall atrophy. Shoulder examination was normal with full range of motion and without signs of impingement. Biceps strength was normal. Cervical spine examination was normal, with only mild left antero-lateral neck discomfort with sidebending to the right Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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