Chest or Rib Pain

Case Description: Pt. is a 16 y/o male who had insidious onset of severe L-sided chest/flank pain upon waking one morning.  He had multiple imaging studies performed including chest x-rays, d-dimer testing, blood panels, and thorough evaluation for cardiac/pulmonary involvement. All test came back negative.  He was a varsity level baseball player and had been unable to participate due to his symptoms. He was referred to physical therapy approximately 3 weeks after onset of his symptoms to determine if there was a musculoskeletal/neuromuscular source to his pain. 

Objective Measures: The patient was seen for 4 physical therapy visits over a 1 month period.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
VAS for Pain	5-9/10	0/10
QuickDASH Scale	75% disability	0% disability
L shoulder AROM/Strength	90° FLEX (severe flank pain)MMT grade: 3/10 (severe pain)	WFL AROM (pain free)MMT grade: 5/5 (pain free)
Thoracic ROM	50% of expected norms	Full and pain free
Functional Capacity	Unable to perform basic bed mobility without assistance	Full participant in varsity baseball practice (pain free)

Summary: The patient was discharged from physical therapy with option for a 3 week follow-up, which was cancelled due to his excellent results.  He returned to full participation in varsity baseball as a pitcher without any remaining chest/rib pain.  

Patient Comments at Discharge: “The fact that I can actually move and be involved in everything I do is so amazing.  (At Full Potential) They keep your mind clear and let you be emotionally OK…”

Sincerely,

Luke Vander Zouwen, DPT
Full Potential Physical Therapy