Right Thoracic Pain

Case Description: Pt is a 57 y/o female who arrived to physical therapy with reports of sharp pain in the R thoracic region/rib cage after having a strong cough for about 2-3 weeks. Pt went to multiple urgent care clinics and went through with various prescriptions including tramadol, prednisone, and gabapentin- all which did not help the pain. X-rays demonstrated no abnormalities. Her biggest complaints were difficulty with self care and high levels of pain while sitting. 

Objective Measures: The patient was seen for 8 physical therapy visits over a course of 1.5 months.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
Numeric pain rating scale	8/10 at highest level	0/10 at highest level
QuickDASH	11% disability	0% disability
Shoulder strength Scapular strength	Decreased strength in shoulder abduction and bilateral mid/lower traps	Full strength in shoulder abduction Full strength in lower traps (5/5) and nearly full in mid traps bilaterally (5-/5)
Range of motion	Moderate decrease in left thoracic rotationMild decrease in right thoracic rotation Pain with cervical extension and flexion	Full and pain free all
Functional Capacity	Difficulty with self care activities, prolonged sitting	Able to sit for prolonged periods of time without pain, no difficulties with house chores or self care

Summary: The patient was discharged from physical therapy due to meeting all goals including pain free daily activities, self care, and sitting. She was given a home exercise program for maintenance of ROM and strength as well as to manage any future flare ups. 

Patient Comments at Discharge: “I wasn’t sure this was going to work for how bad my pain was- but I was proven wrong and I’m doing great.”