Rib Pain

Case Description: Pt. is a 37 y/o female who developed severe R flank pain over a 3 mo period after a coughing fit due to her asthma. She had a number of imaging studies including chest x-rays and test to rule of pulmonary embolism. All tests came back negative.  Her pain was so severe that she was worried she would have to take a leave of absence from work and was having difficulty caring for her 2 young children. She reported basically non-functional use of her RUE and difficulty with breathing.  

Objective Measures: The patient was seen for 16 visits over a 2.5 month period.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
VAS for Pain	8-9/10	0-1/10
QuickDASH Scale	90.9% disability	0% disability
R shoulder AROM/Strength	90° FLEX (severe flank pain)MMT grade: 35 (severe pain)	WFL AROM (pain free)MMT grade: 5/5 (pain free)
Thoracic ROM	25-50% of expected norms for sidebending and rotation	Full and pain free
Functional Capacity	Unable to take deep breath or functionally use RUE	Able to perform work/home duties without limitation

Summary: The patient was eventually discharged from physical therapy without report of functional limitation. Her treatment consistent of manual therapy to address thoracic/rib cage stiffness as well as increased muscle tone due to guarding.  Exercise consisted of therapeutic exercise based on strengthening/ROM as well as neuromuscular re-education to improve trunk/shoulder girdle control to avoid further flare-ups.   

Patient Comments at Discharge: “I am once again able to do all the day to day ‘normal’ life activities again.  I especially love being able to pick up my little guy.”

Sincerely,

Luke Vander Zouwen, DPT
Full Potential Physical Therapy