Too Much Pain, No Gain: Rib Stress Fracture In A Cross Fit Athlete

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Too Much Pain, No Gain: Rib Stress Fracture In A Cross Fit Athlete - Page #1

Author: Rony Skaria, MD Co Author #1: Kevin Crawford, MD Co Author #2: David Edwards, MD Patient Presentation: 20 year old woman with a four month history of left sided chest pain and mild left shoulder pain History: Experienced Cross-FitTM athlete training 6x/wk, one hour sessions. Pain started as soreness with overhead workouts, over 2-3 weeks. Sudden sharp pain during an overhead workout; limiting ability to do dips, pushups, pull-ups or rows. Exacerbated by activities of daily living (reaching overhead, driving and deep inspiration). Gradually improved with rest, but pain resumed when attempting to restart workouts 6 wks later. No history of systemic symptoms; balanced diet, daily direct sunlight exposure Past Medical History: oligomenorrhea, nine cycles in past year, no fractures or malignancies No medications taken for the pain Meds: calcium 1200mg daily and Vit D3 400 IU daily Physical Exam: Vitals: within normal limits Height: 5’4'', Weight: 150 lbs, BMI: 25.7 General: pleasant and cooperative, muscular build Neurologic: sensation intact to fine touch over LUE C5-T1 Skin: no rashes or vesicles Respiratory: equal chest movement bilaterally and normal work of breathing; pain on left side with deep inspiration Musculoskeletal: bony tenderness to palpation at mid axillary line at the left 4th rib, worsened with anterior to posterior compression of rib cage; no palpable mass or hematoma, no bony crepitus; no winging of scapula with wall pushup; pain worsened with left lateral flexion and rotation of trunk Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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