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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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2
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Mumtaz ZUA, Desai SR, Padley SPG. Frequency of extracardiac findings on "negative" CT coronary angiography studies. Clin Radiol 2024; 79:e334-e343. [PMID: 38092649 DOI: 10.1016/j.crad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/02/2024]
Abstract
AIM To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
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Affiliation(s)
- Z-U-A Mumtaz
- Faculty of Medicine, Imperial College School of Medicine, London, UK.
| | - S R Desai
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, UK
| | - S P G Padley
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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3
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Sarıkaya B, Dede BT, Bağcıer F, Yıldızgören MT. Letter to the Editor: Treating Muscle-Induced Chest Pain: Needling 2 Anatomical Structures in the Same Session. Med Acupunct 2024; 36:55-56. [PMID: 38380165 PMCID: PMC10874813 DOI: 10.1089/acu.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Beyza Sarıkaya
- Department: Clinic of Physical Medicine and Rehabilitation, Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Tayyip Dede
- Clinic of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Fatih Bağcıer
- Department: Clinic of Physical Medicine and Rehabilitation, Cam and Sakura City Hospital, Istanbul, Turkey
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Koubaa A, Kammoun N, Kotti N, Hentati Y, Tekaya R, Bani M, Nouaigui H. Post-traumatic Tietze syndrome as an occupational accident: A case report study. Trauma Case Rep 2023; 47:100894. [PMID: 37608875 PMCID: PMC10440352 DOI: 10.1016/j.tcr.2023.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
Tietze syndrome is an inflammatory arthropathy of costochondral junction characterized by chest pain, tenderness and swelling. We reported the case of a 35-year-old worker with post traumatic Tietze syndrome. He had a history of two occupational chest traumas. They both occurred in the third left costo-chondral joint. Chest computed tomography showed located osteolysis. Differential diagnoses were excluded. He was treated with non-steroidal anti-inflammatory drugs and analgesics. As for partial permanent disability, we suggested 17% given the importance of the pain and its impact on mobility. Tietze syndrome diagnosis was based on eliminating differential diagnoses. This study raises knowledge about post-traumatic etiology in Tietze syndrome. A better understanding of this pathology could help practitioners with patients facing chest wall pain.
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Affiliation(s)
- Asma Koubaa
- Occupational Health and Safety Institute, Faculty of Medicine of Tunis, University Tunis Manar, Tunisia
| | - Nesrine Kammoun
- Occupational Health and Safety Institute, Faculty of Medicine of Tunis, University Tunis Manar, Tunisia
| | - Nada Kotti
- Department of Occupational Medicine, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Yosr Hentati
- Department of Radiology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Rawdha Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis Manar, Tunisia
| | - Mejda Bani
- Occupational Health and Safety Institute, Faculty of Medicine of Tunis, University Tunis Manar, Tunisia
| | - Habib Nouaigui
- Occupational Health and Safety Institute, Faculty of Medicine of Tunis, University Tunis Manar, Tunisia
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5
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Becker RC. Evaluating chest pain in patients with post COVID conditions permission to think outside of the box. J Thromb Thrombolysis 2023; 55:592-603. [PMID: 37052772 PMCID: PMC10098243 DOI: 10.1007/s11239-023-02808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
Chest pain is among the most common symptoms of post-COVID-19 Conditions (PCC) that prompts medical attention. Because the SARS-CoV-2 virus has proclivity for many organs and organ systems in the chest, ranging from the heart, lungs, great vessels, lymphatics, and peripheral nerves, clinicians evaluating patients with chest pain must consider a broad differential diagnosis and take a comprehensive approach to management.
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Kuridze N, Okuashvili I, Tsverava M, Minadze E. Tietze Syndrome as a Cause of Chest Pain in the Post-COVID-19 Period. Cureus 2023; 15:e37360. [PMID: 37182083 PMCID: PMC10170415 DOI: 10.7759/cureus.37360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Tietze syndrome is a rare disease. It is mainly characterized by chest pain caused by a unilateral and monoarticular lesion of the second-fifth costal joints. Tietze syndrome is one of the potential complications in the post-COVID-19 period. It is one of the differential diagnoses for non-ischemic chest pain. With early diagnosis and appropriate treatment, this syndrome is easily manageable. The authors present a case of a 38-year-old male who had been diagnosed with Tietze syndrome in the post-coronavirus disease 2019 (COVID-19) period.
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Affiliation(s)
- Nika Kuridze
- Faculty of Clinical and Translational Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, GEO
- Rhythmology Department, G. Chapidze Emergency Cardiology Center, Tbilisi, GEO
| | - Ivditi Okuashvili
- Outpatient Department, G. Chapidze Emergency Cardiology Center, Tbilisi, GEO
| | - Mikheil Tsverava
- Outpatient Department, G. Chapidze Emergency Cardiology Center, Tbilisi, GEO
- Faculty of Internal Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, GEO
| | - Eteri Minadze
- Faculty of Internal Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, GEO
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Choi MH, Yoon IY, Kim WJ. Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis: A case report. World J Clin Cases 2023; 11:2043-2050. [PMID: 36998969 PMCID: PMC10044947 DOI: 10.12998/wjcc.v11.i9.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Manubriosternal joint (MSJ) disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement. In patients with ankylosing spondylitis (AS), a type of systemic arthritis, chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.
CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain. There were no abnormal findings on lateral sternum X-ray, but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography. We performed additional laboratory tests, and he was finally diagnosed with AS. For pain relief, we performed ultrasound-guided intra-articular (IA) corticosteroid injections into the MSJ. After the injections, his pain nearly resolved.
CONCLUSION For patients complaining of anterior chest pain, AS should be considered, and single-photon emission computed tomography-computed tomography can be helpful in diagnosis. In addition, ultrasound-guided IA corticosteroid injections may be effective for pain relief.
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Affiliation(s)
- Min-Hee Choi
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - In-Young Yoon
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
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Hashemi M, Mahmood SMJ, Fernandez J, Oswald J. Cryoneurolysis of Intercostal Nerve for Rib Trauma and Intercostal Neuralgia in the Emergency Department: A Multidisciplinary Approach. J Emerg Med 2022; 63:376-381. [PMID: 36241475 DOI: 10.1016/j.jemermed.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Management of pain from traumatic rib injury is very challenging. Both acute and chronic pain caused by rib injury can cause significant morbidity (pain-induced hypoventilation, pneumonia, respiratory failure) and functional hindrance. Traditional pain management strategies in the emergency department (ED) that target acute traumatic rib pain are limited by the side effects of medications or the temporary half-life of anesthetics used for a nerve block. Both treatment modalities fall short of addressing subsequent chronic sequelae. CASE REPORT We present the first-time use of cryoneurolysis on an ED patient for the treatment of 10/10 severe traumatic intercostal neuralgia that resulted in the patient being discharged home pain free. The patient initially underwent a multilevel left-sided T5-T7 intercostal nerve block, followed by ultrasound-guided percutaneous cryoneurolysis of those intercostal nerves using two cycles of 2 min of cooling to a temperature of -70°C (nitrous oxide), with 30 s of thawing in between. The patient experienced 100% pain relief immediately post procedure that was sustained. He remained completely symptom free more than 6 months after the bedside procedure and returned to sports without restrictions. Why Should an Emergency Physician Be Aware of This? This case highlights the benefits of cross-departmental collaboration between the ED, Anesthesia, and Pain Management. We hope this model of multidisciplinary pain modulation can be replicated for other patients with similar pain and can herald a new paradigm of pain management in the ED.
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Affiliation(s)
- Mani Hashemi
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, Florida
| | - S M Jafar Mahmood
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jorge Fernandez
- Department of Emergency Medicine, UC San Diego, San Diego, California
| | - Jessica Oswald
- Department of Emergency Medicine, UC San Diego, San Diego, California; Department of Anesthesia, Division of Pain Medicine, UC San Diego, La Jolla, California
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9
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Stowell JT, Walker CM, Chung JH, Bang TJ, Carter BW, Christensen JD, Donnelly EF, Hanna TN, Hobbs SB, Johnson BD, Kandathil A, Lo BM, Madan R, Majercik S, Moore WH, Kanne JP. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. J Am Coll Radiol 2021; 18:S394-S405. [PMID: 34794596 DOI: 10.1016/j.jacr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings, and is often of musculoskeletal origin in the former. Chest wall syndrome collectively describes the various entities that can contribute to chest wall pain of musculoskeletal origin and may affect any chest wall structure. Various imaging modalities may be employed for the diagnosis of nontraumatic chest wall conditions, each with variable utility depending on the clinical scenario. We review the evidence for or against use of various imaging modalities for the diagnosis of nontraumatic chest wall pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Jonathan H Chung
- Panel Chair; and Vice-Chair, Quality and Section Chief, Chest Imaging, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Tami J Bang
- Co-Director, Cardiothoracic Imaging Fellowship Committee, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Co-Chair, membership committee, NASCI; and Membership committee, ad-hoc online content committee, STR
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared D Christensen
- Vice-Chair, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and Chair, Lung-RADS
| | - Edwin F Donnelly
- Chief, Thoracic Imaging, Ohio State University, Columbus, Ohio; Co-Chair Physics Module Committee, RSNA
| | - Tarek N Hanna
- Associate Director, Emergency and Trauma Imaging, Emory University, Atlanta, Georgia; and Director-at-Large, American Society of Emergency Radiology
| | - Stephen B Hobbs
- Vice-Chair, Informatics and Integrated Clinical Operations and Division Chief, Cardiovascular and Thoracic Radiology, University of Kentucky, Lexington, Kentucky
| | | | | | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; and Board Member, American College of Emergency Physicians
| | - Rachna Madan
- Associate Fellowship Director, Division of Thoracic Imaging, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sarah Majercik
- Vice-Chair, Surgery for Research and Director, Trauma Research, Intermountain Medical Center, Salt Lake City, Utah; and American Association for the Surgery of Trauma
| | - William H Moore
- Associate Chair, Clinical Informatics and Chief, Thoracic Imaging, New York University Langone Medical Center, New York, New York
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Local treatment of pain in Tietze syndrome: A single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:239-247. [PMID: 34104518 PMCID: PMC8167461 DOI: 10.5606/tgkdc.dergisi.2021.21120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
Background
In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome.
Methods
Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination.
Results
At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection.
Conclusion
Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.
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11
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Barranco-Trabi J, Mank V, Roberts J, Newman DP. Atypical Costochondritis: Complete Resolution of Symptoms After Rib Manipulation and Soft Tissue Mobilization. Cureus 2021; 13:e14369. [PMID: 33976991 PMCID: PMC8106472 DOI: 10.7759/cureus.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Costochondritis is a self-limiting, poorly described, and benign condition that usually manifests as non-cardiac chest pain. The symptoms usually tend to resolve in a couple of weeks. Serious causes of chest pain should be ruled out prior to diagnosing costochondritis, as it is often a diagnosis of exclusion. Costochondritis that does not self-resolve is referred to as atypical costochondritis and is associated with high medical expenses and psychological burden on the patient. In this report, we discuss the case of a 37-year-old healthy male patient who presented with a two-year history of intermittent pain along the right anterolateral rib cage without any history of trauma. After extensive diagnostic work-up by Cardiology and Gastroenterology, Physical Medicine and Rehabilitation (PM&R) got involved. The initial diagnosis of chest pain evolved into atypical costochondritis given the time course, physical examination findings of focal tenderness, along with normal laboratory values, electrocardiogram, and imaging studies. A multimodal approach was adopted for the treatment of this patient, including manipulative therapy to determine if regional interdependence was present, followed by instrument-assisted soft tissue mobilization (IASTM) and stretching to address the potential myofascial pain generators. After three appointments, there was complete resolution of morning pain and there was no pain upon examination. This case highlights how osteopathic manipulation techniques (OMT) can be useful in the treatment of rib dysfunction, especially in atypical costochondritis. Further studies are required to expand our knowledge of costochondritis and physical therapy (PT) techniques, which would allow for early identification and effective treatment of the condition.
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Affiliation(s)
| | - Victoria Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA
| | - Jefferson Roberts
- Department of Rheumatology, Tripler Army Medical Center, Honolulu, USA
| | - David P Newman
- Pain Management-Physiotherapy, Tripler Army Medical Center, Honolulu, USA
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12
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Zmyślna A, Żurawski AŁ, Śliwiński G, Śliwiński ZW, Kiebzak WP. Assessment of Body Posture of Children With Chest Pain. Front Pediatr 2021; 9:704087. [PMID: 34485195 PMCID: PMC8416038 DOI: 10.3389/fped.2021.704087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders. Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system. Methods: The study involved a group of 184 female and male children, aged 7-12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system. Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group. Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9-10 and 11-12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable. In the study group, among children aged 9-10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group. Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.
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Affiliation(s)
- Anna Zmyślna
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
| | - Arkadiusz Łukasz Żurawski
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
| | - Grzegorz Śliwiński
- Faculty of Electrical and Computer Engineering, Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | | | - Wojciech Piotr Kiebzak
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
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Squillaro AI, Sanders K, Onwubiko C, Chang CJ, Kim S. Laparoscopic Treatment of Slipping Rib Syndrome in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2020; 30:1253-1256. [DOI: 10.1089/lap.2020.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anthony I. Squillaro
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Katherine Sanders
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Chinwendu Onwubiko
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California, USA
| | - Cindy J. Chang
- Departments of Orthopedic Surgery and Family & Community Medicine, Primary Care Sports Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sunghoon Kim
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California, USA
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14
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Newman DP, Jansen BJ, Scozzafava A, Smith R, Mclean BC. Rib Mediated Non-Cardiac Chest Pain: A Case Report. Cureus 2020; 12:e10831. [PMID: 33173637 PMCID: PMC7645301 DOI: 10.7759/cureus.10831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Non-cardiac chest pain (NCCP) is a very common and functionally limiting pain complaint that vexes patients and medical providers leading to time-consuming and expensive diagnostic work-ups as well as significant disability and lost productivity. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, or interventional management procedures for the diagnosis and alleviation of NCCP. In patients presenting with chest pain, after ruling out life-threatening causes, the diagnosis of NCCP is made. This process is a diagnosis of exclusion rather than a specific etiology with a defined treatment plan. This results in specialty consultation, advanced diagnostic testing, and delayed definitive care. A better triage process may include the incorporation of diagnostic maneuvers at the primary care and emergency room to justify referral to a musculoskeletal specialist in lieu of or during advanced diagnostic work-up. After the diagnosis of NCCP is made in our young and active patient population, we have seen significant success in the application of manipulation and a functional restoration program similar to the presented case. To our knowledge, this treatment approach has not been previously described. While this management strategy may be taught in physiotherapy courses, we provide the case to illustrate a multimodal treatment approach that seems to be unknown or underutilized based on the number of referrals and prevalence of this condition.
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Affiliation(s)
- David P Newman
- Interdisciplinary Pain Management Clinic, Tripler Army Medical Center, Honolulu, USA
| | | | | | - Ryan Smith
- Cardiology, Adventist Health System, Kailua, USA
| | - Brian C Mclean
- Pain Management, Landstuhl Regional Medical Center, Landstuhl, DEU
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Bader AS, Rubinowitz AN, Gange CP, Bader EM, Cortopassi IO. Imaging in the Evaluation of Chest Pain in the Primary Care Setting, Part 2: Sources of Noncardiac Chest Pain. Am J Med 2020; 133:1135-1142. [PMID: 32442508 DOI: 10.1016/j.amjmed.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022]
Abstract
Chest pain is a common presenting complaint in the primary care setting. Imaging plays a key role in the evaluation of the multiple organ systems that can be responsible for chest pain. With numerous imaging modalities available, determination of the most appropriate test and interpretation of the findings can be a challenge for the clinician. In this 2-part series, we offer resources to guide primary care physicians in the selection of imaging studies and present the imaging findings of various causes of nonemergent chest pain. In Part 2, we focus on the radiologic appearance of common noncardiac sources of chest pain, including gastrointestinal, pulmonary, and musculoskeletal etiologies.
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Affiliation(s)
| | | | | | - Eric M Bader
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn
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Koch J, Tsui C, Talsma J, Pierce-Talsma S. Osteopathic Manipulative Treatment for Inhaled Rib Somatic Dysfunction. J Osteopath Med 2020; 120:2765205. [PMID: 32722750 DOI: 10.7556/jaoa.2020.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Ultrasound-Guided Corticosteroid Injection in a Patient With Tietze Syndrome Combined With Costochondral Joint Swelling. Am J Phys Med Rehabil 2020; 98:e71-e73. [PMID: 30362978 DOI: 10.1097/phm.0000000000001072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tietze syndrome is an uncommon disease of unknown etiology that manifests as pain and tenderness of the parasternal joints. To date, however, there has been no report on ultrasonographic findings concerning swelling of the costochondral joint in Tietze syndrome. Moreover, there has been no research investigating images of ultrasound-guided corticosteroid injection, although corticosteroid injection is one of the most important treatments for Tietze syndrome. Therefore, we report a case of Tietze syndrome where ultrasound images were used in the diagnostic and therapeutic process. A 70-yr-old man was seen for left chest pain that had lasted for several weeks. Physical examination at our clinic revealed a focal tenderness of the left third costochondral joint, and an ultrasound showed a swelling of the left third costochondral joint. Considering both the radiological and the clinical examination, the patient received a diagnosis of Tietze syndrome with costochondral joint swelling. Then, the patient agreed to an ultrasound-guided left third costochondral corticosteroid injection after receiving a detailed explanation of the disease and treatment. After receiving three ultrasound-guided corticosteroid injections, his chest pain subsided, and the swelling and tenderness also disappeared completely. Collectively, our case suggests that ultrasound is important in the diagnosis and treatment of Tietze syndrome.
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Kamiński M, Łoniewski I, Marlicz W. "Dr. Google, I am in Pain"-Global Internet Searches Associated with Pain: A Retrospective Analysis of Google Trends Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E954. [PMID: 32033087 PMCID: PMC7037174 DOI: 10.3390/ijerph17030954] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
We aimed to rank the most common locations of pain among Google users globally and locally and analyze secular and seasonal trends in pain-related searches in the years 2004-2019. We used data generated by Google Trends (GT) to identify and analyze global interest in topics (n = 24) related to locations of pain and how these progressed over time. We analyzed secular trends and time series decomposition to identify seasonal variations. We also calculated the interest in all topics with reference to the relative search volume (RSV) of "Abdominal pain". Google users were most commonly interested in "Headache" (1.30 [times more frequently than "Abdominal pain"]), "Abdominal pain" (1.00), and "Back pain" (0.84). "Headache" was the most frequent search term in n = 41 countries, while "Abdominal pain" was the most frequent term in n = 27 countries. The interest in all pain-related topics except "Dyspareunia" increased over time. The sharpest increase was observed for "Abdominal pain" (5.67 RSV/year), and "Toothache" (5.52 RSV/year). Most of the topics revealed seasonal variations. Among pain-related topics, "Headache," "Abdominal pain," and "Back pain" interested most Google users. GT is a novel tool that allows retrospective investigation of complaints among Internet users.
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Affiliation(s)
- Mikołaj Kamiński
- Sanprobi Sp.z.o.o. Sp.K., 70-535 Szczecin, Poland
- Faculty of Medicine I, Poznan University of Medical Sciences, 60-780 Poznan, Poland
| | - Igor Łoniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland;
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Gelley G, Zarrabian M, Passmore S. Emergency Department Clinician Experiences and Perceptions Regarding Noncardiac Chest Pain: A Cross-Sectional Survey. J Manipulative Physiol Ther 2019; 42:159-166. [PMID: 31029468 DOI: 10.1016/j.jmpt.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 11/17/2017] [Accepted: 02/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study are to report the responses of emergency department (ED) clinicians regarding the characteristics and management of patients with noncardiac chest pain (NCCP) and to explore clinician experiences with the current standard of care and whether nonpharmacologic or nonsurgical referral options would be considered. METHODS A cross-sectional survey was delivered to 40 ED clinicians from hospitals in Winnipeg, Manitoba from 2012 to 2013. Data were reduced descriptively and thematically summarized to assess the characteristics of patients with NCCP along with the responses of ED clinicians regarding the management of NCCP. RESULTS The survey response was 27 (67.5% response rate). They reported that patients with NCCP comprised a considerable amount of ED care and are a variable and heterogeneous population. Respondents agreed (63.0%) that onsite and on-call providers for NCCP referral would assist in patient management. Further, ED clinicians (66.7%) would consider referring patients with NCCP to a nonpharmacologic, nonsurgical clinical research study. CONCLUSION Clinicians in this study wanted better access to on-site referrals and outpatient clinics for patients experiencing NCCP after discharge and would consider nonpharmacologic or nonsurgical referral.
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Affiliation(s)
- Geoffrey Gelley
- Rady Faculty of Health Sciences, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Mohammad Zarrabian
- Section of Orthopedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven Passmore
- Rady Faculty of Health Sciences, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Faculty of Kinesiology & Recreation Management, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Sawada K, Ihoriya H, Yamada T, Yumoto T, Tsukahara K, Osako T, Naito H, Nakao A. A patient presenting painful chest wall swelling: Tietze syndrome. World J Emerg Med 2019; 10:122-124. [PMID: 30687451 DOI: 10.5847/wjem.j.1920-8642.2019.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kohei Sawada
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Hiromi Ihoriya
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Taihei Yamada
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Takaaki Osako
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
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Abstract
Positional complications in spine surgery are not uncommon. Commonly encountered complications include ocular and aural, other than musculoskeletal injuries. However, development of Tietze's syndrome due to malpositioning has not been reported till date. A 40-year-old male patient presented with postlaminectomy syndrome, for which posterior pedicle screw fixation and fusion was performed. Postoperatively, patient complained of new-onset pain associated with redness and swelling at parasternal region. After thorough radiological investigations, he was diagnosed with Tietze's syndrome at 6th and 7th costo-cartilaginous junction. Tietze's syndrome is itself a rare entity, and its association with malpositioning during prone positioning is uncommon. It is important for the surgeons to be aware of the condition as Tietze's syndrome may be encountered as an off-centered complication due to malpositioning.
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Affiliation(s)
- Viswanadha Arun Kumar
- Mallika Spine Centre, 12-12-30, Old Club Road, Kothapet, Guntur, 522
001 Andhra Pradesh India
| | - J. Naresh Babu
- Mallika Spine Centre, 12-12-30, Old Club Road, Kothapet, Guntur, 522
001 Andhra Pradesh India
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What do we know about Tietze's syndrome? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:180-182. [PMID: 30310397 PMCID: PMC6180027 DOI: 10.5114/kitp.2018.78443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 11/17/2022]
Abstract
Tietze's syndrome is a benign, self-limiting arthropathy, without purulent character. The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints. The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side. Diagnosis of Tietze's syndrome is based on physical examination (increase of palpation tenderness in the affected joint), laboratory tests (increase of inflammatory parameters) and imaging studies (USG, MRI). Differential diagnosis of Tietze's syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome and inflammatory changes in the lung and pleura. Most commonly the treatment is conservative, in resistant cases surgical.
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Abstract
We present an interesting image of a 62-year-old woman revealed with Tietze syndrome by F-FDG PET/CT and bone scintigraphy. She presented with right upper chest wall pain with a hard, palpable mass. However, chest radiograph and CT were unrevealing. On PET/CT, intense FDG uptake was noted at the anterior aspect of the right second costal cartilage with dense calcification, which was the correct symptomatic lesion. Bone scan showed increased radioactive uptake at the FDG uptake lesion, but mild uptake was also seen in the asymptomatic lesion.
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Abstract
Noncardiac chest pain is an angina-type discomfort without indication of ischemia. Diagnosis can be difficult because of its heterogeneous nature. Classification varies by specialty; gastroenterology uses the terminology gastroesophageal reflux disease related versus non-gastroesophageal reflux disease related. Other disciplines recognize noncardiac chest pain etiologies as having gastrointestinal, musculoskeletal, psychiatric, or pulmonary/other as underlying etiologies. Diagnostics yield a specific cause for effective treatment, which is aimed at the underlying etiology, but it is not always possible. Some patients with noncardiac chest pain have comorbidities and ongoing pain that lead to decreased quality of life and continued health care use.
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Affiliation(s)
- Sharron Rushton
- Duke University School of Nursing, DUMC Box 3322, Durham, NC 27710, USA.
| | - Margaret J Carman
- Georgetown University School of Nursing and Health Studies, St. Mary's Hall, 3700 Reservoir Road Northwest, Washington, DC 20007, USA
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Gasparri M, Gasparri M. Slipping Rib Syndrome and Other Causes of Chest Wall Pain. RIB FRACTURE MANAGEMENT 2018:105-116. [DOI: 10.1007/978-3-319-91644-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Surgical Management of Medically Refractory Tietze Syndrome. Ann Thorac Surg 2017; 104:e443-e445. [PMID: 29153814 DOI: 10.1016/j.athoracsur.2017.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022]
Abstract
Tietze syndrome is a rare and benign cause of chest pain that may be confused with life-threatening conditions. Characteristic findings are painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints typically of the second and third ribs. We present a patient with severe, medically refractory symptoms consistent with Tietze syndrome. Although surgical management is not the typical treatment course, symptomatic control was eventually achieved with complete resection of the involved cartilage and adjacent rib. We propose surgical management in patients with debilitating cases of Tietze syndrome that are resistant to conservative therapies.
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Moran B, Bryan S, Farrar T, Salud C, Visser G, Decuba R, Renelus D, Buckley T, Dressing M, Peterkin N, Coris E. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes. Curr Sports Med Rep 2017; 16:84-94. [PMID: 28282354 DOI: 10.1249/jsr.0000000000000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.
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Affiliation(s)
- Byron Moran
- 1Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 2Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 3The University of South Carolina School of Medicine, Greenville, SC; 4Primary Care Sports Medicine Fellowship, University of South Florida-Morton Plant Mease, Clearwater, FL; 5Baycare Medical Group Primary Care, St. Petersburg, FL; 6Premiere Med Family and Sports Medicine, Ocoee, FL; 7Family Medicine Residency Program, University of South Florida-Morton Plant Mease, Clearwater, FL; 8Bayfront Primary Care Sports Medicine Fellowship, St. Petersburg, FL; 9Morsani College of Medicine, University of South Florida, Tampa, FL; 10Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL; and 11Baptist Primary Care, Jacksonville, FL; and 12Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
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Yoo WG. Effects of combined chest expansion and breathing exercises in a patient with sternal pain. J Phys Ther Sci 2017; 29:1706-1707. [PMID: 28932017 PMCID: PMC5599850 DOI: 10.1589/jpts.29.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effects of combined chest expansion and breathing exercises
in a patient with sternal pain. [Subject and Methods] The study subject was a 36-year-old
female employed as a babysitter who complained of sternal pain at the T1–4 level. The
subject performed the combined chest expansion and breathing exercises. [Results] The
thoracic kyphosis angle after combined chest expansion and breathing exercises decreased
compared with the initial angle. The sternal pain after these exercises also decreased
compared with the initial value. [Conclusion] This study suggests that combined chest
expansion and breathing exercises can be effective in treating sternal pain.
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Affiliation(s)
- Won-Gyu Yoo
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Inje University: 607 Obangdong, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea
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29
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Yoo WG. Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain. J Phys Ther Sci 2017; 29:1481-1482. [PMID: 28878487 PMCID: PMC5574339 DOI: 10.1589/jpts.29.1481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/29/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study developed a combined thoracic and backward lifting exercise for thoracic kyphosis angle and intercostal muscle pain. [Subject and Methods] The subject was a 41-year-old man who complained of upper thoracic and intercostal pain. He performed the combined thoracic and backward lifting exercise for 15 days. [Results] The initial VAS score for the intercostal area was 4/10. The VAS score decreased to 1/10 after the thoracic exercise combined with backward lifting. The initial thoracic kyphosis angle was 38° and it decreased to 32° after the exercise period. [Conclusion] Therefore, backward lifting and thoracic extension is a good posture for activating the different layers of muscle that are attached to the ribs. The kyphosis angle is also reduced by providing sufficient resistance during the thoracic exercise.
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Affiliation(s)
- Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic. J Cardiovasc Nurs 2017; 32:E1-E8. [DOI: 10.1097/jcn.0000000000000374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Geyser M, Smith S. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria. Afr J Prim Health Care Fam Med 2016; 8:e1-5. [PMID: 27380782 PMCID: PMC4926718 DOI: 10.4102/phcfm.v8i1.1048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 03/31/2016] [Accepted: 01/14/2016] [Indexed: 11/04/2022] Open
Abstract
Background Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). Aim The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. Methods Records of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown. Results Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission. Conclusion The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.
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Affiliation(s)
- Mimi Geyser
- Department of Family Medicine, University of Pretoria, Pretoria.
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Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases. J Chiropr Med 2016; 15:67-73. [PMID: 27069435 DOI: 10.1016/j.jcm.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/20/2015] [Accepted: 12/28/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic. CLINICAL FEATURES A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation. INTERVENTION AND OUTCOME In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting. CONCLUSION Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Morris CE, Bonnefin D, Darville C. The Torsional Upper Crossed Syndrome: A multi-planar update to Janda's model, with a case series introduction of the mid-pectoral fascial lesion as an associated etiological factor. J Bodyw Mov Ther 2015; 19:681-9. [DOI: 10.1016/j.jbmt.2015.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/06/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
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Lanham DA, Taylor AN, Chessell SJ, Lanham JG. Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond) 2015; 76:296-300. [PMID: 25959942 DOI: 10.12968/hmed.2015.76.5.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A simple clinical approach to patients presenting with chest pain is outlined, which is easily taught and can be quickly applied. This approach was demonstrated in a large cohort of patients and this article discusses the characteristics of the various diagnostic sub-groups.
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Affiliation(s)
- David A Lanham
- Foundation Year 2 Doctor in the Department of Medicine, Macclesfield District General Hospital, Macclesfield
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Berg AT, Stafne SN, Hiller A, Slørdahl SA, Aamot IL. Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial. SAGE Open Med 2015; 3:2050312115580799. [PMID: 26770781 PMCID: PMC4679239 DOI: 10.1177/2050312115580799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/03/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To assess the effect of two different physical therapy interventions in patients with stable coronary heart disease and non-cardiac chest pain. METHODS A randomized controlled trial was carried out at a university hospital in Norway. A total of 30 patients with known and stable coronary heart disease and self-reported persistent chest pain reproduced by palpation of intercostal trigger points were participating in the study. The intervention was deep friction massage and heat pack versus heat pack only. The primary outcome was pain intensity after the intervention period and 3 months after the last treatment session, measured by Visual Analogue Scale, 0 to 100. Secondary outcome was health-related quality of life. RESULTS Treatment with deep friction massage and heat pack gave significant pain reduction compared to heat pack only (-17.6, 95% confidence interval: -30.5, -4.7; p < 0.01), and the reduction was persistent at 3 months' follow-up (-15.2, 95% confidence interval: -28.5, -1.8; p = 0.03). Health-related quality of life improved in all three domains in patients with no significant difference between groups. CONCLUSION Deep friction massage combined with heat pack is an efficient treatment of musculoskeletal chest pain in patients with stable coronary heart disease.
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Affiliation(s)
- Astrid T Berg
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Signe N Stafne
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aud Hiller
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stig A Slørdahl
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Inger-Lise Aamot
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Burgstaller JM, Jenni BF, Steurer J, Held U, Wertli MM. Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis. PLoS One 2014; 9:e104722. [PMID: 25111147 PMCID: PMC4128723 DOI: 10.1371/journal.pone.0104722] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/12/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Non-cardiovascular chest pain (NCCP) leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment. OBJECTIVES To summarize treatment efficacy for patients presenting with NCCP. METHODS Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs) evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group). RESULTS Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10). Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)]. The pooled OR in GERD negative patients (4 RCTs, 156 patients) was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%). In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%)]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions. LIMITATIONS Only a small number of studies were available. CONCLUSIONS Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available for most prevalent diseases manifesting with chest pain. In patients with idiopathic NCCP, treatments based on cognitive behavioral principles might be considered.
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Affiliation(s)
- Jakob M. Burgstaller
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Boris F. Jenni
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Johann Steurer
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Maria M. Wertli
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
- Cantonal Hospital Winterthur, Winterthur, Switzerland
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Ayloo A, Cvengros T, Marella S. Evaluation and Treatment of Musculoskeletal Chest Pain. Prim Care 2013; 40:863-87, viii. [DOI: 10.1016/j.pop.2013.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis. BMC Med 2013; 11:239. [PMID: 24207111 PMCID: PMC4226211 DOI: 10.1186/1741-7015-11-239] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/15/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Non-cardiovascular chest pain (NCCP) has a high healthcare cost, but insufficient guidelines exist for its diagnostic investigation. The objective of the present work was to identify important diagnostic indicators and their accuracy for specific and non-specific conditions underlying NCCP. METHODS A systematic review and meta-analysis were performed. In May 2012, six databases were searched. Hand and bibliography searches were also conducted. Studies evaluating a diagnostic test against a reference test in patients with NCCP were included. Exclusion criteria were having <30 patients per group, and evaluating diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given in likelihood ratios (LR): very good (LR+ >10, LR- <0.1); good (LR + 5 to 10, LR- 0.1 to 0.2); fair (LR + 2 to 5, LR- 0.2 to 0.5); or poor (LR + 1 to 2, LR- 0.5 to 1). Joined meta-analysis of the diagnostic test sensitivity and specificity was performed by applying a hierarchical Bayesian model. RESULTS Out of 6,316 records, 260 were reviewed in full text, and 28 were included: 20 investigating gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 psychiatric conditions. Study quality was good in 15 studies and moderate in 13. GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was also more likely with a positive response to a proton pump inhibitor (PPI) test (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and anxiety screening scores can identify individuals requiring further testing for anxiety or panic disorders. Clinical findings in musculoskeletal pain either had a fair to moderate LR + and a poor LR- or vice versa. CONCLUSIONS In patients with NCCP, thorough clinical evaluation of the patient's history, symptoms, and clinical findings can indicate the most appropriate diagnostic tests. Treatment response to high-dose PPI treatment provides important information regarding GERD, and should be considered early. Panic and anxiety disorders are often undiagnosed and should be considered in the differential diagnosis of chest pain.
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Stochkendahl MJ, Christensen HW, Vach W, Høilund-Carlsen PF, Haghfelt T, Hartvigsen J. Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome. J Manipulative Physiol Ther 2011; 35:7-17. [PMID: 22185955 DOI: 10.1016/j.jmpt.2010.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 04/16/2011] [Accepted: 05/01/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2) self-management as an example of minimal intervention. METHODS In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). RESULTS Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor of chiropractic treatment at 4 weeks regarding the primary outcome of self-perceived change in chest pain and at 12 weeks with respect to the primary outcome of numeric change in pain intensity. CONCLUSIONS To the best of our knowledge, this is the first randomized trial assessing chiropractic treatment vs minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients is needed.
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Affiliation(s)
- Mette J Stochkendahl
- Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics and Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Part of Clinical Locomotion Science, Odense, Denmark.
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Kienzl D, Prosch H, Töpker M, Herold C. Imaging of non-cardiac, non-traumatic causes of acute chest pain. Eur J Radiol 2011; 81:3669-74. [PMID: 21466934 DOI: 10.1016/j.ejrad.2011.02.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 11/18/2022]
Abstract
Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.
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Affiliation(s)
- Daniela Kienzl
- Department of Radiology, Medical University of Vienna, Austria.
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Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain. J Chiropr Med 2011; 10:60-3. [PMID: 22027210 DOI: 10.1016/j.jcm.2010.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 09/21/2010] [Accepted: 10/21/2010] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the clinical presentation and chiropractic management of Tietze syndrome. CLINICAL FEATURES A 34-year-old woman presented with unexplained left-sided chest pain. Electrocardiogram and radiographs were taken at a medical emergency department to rule out cardiovascular and pulmonary causes, and pain medication did not relieve her pain. Physical examination showed tenderness on palpation and swelling of the second and third chondrosternal joints, as well as thoracic joint dysfunction. Heart and lung pathology was ruled out, and chondrosternal joint swelling was present, Tietze syndrome was diagnosed. INTERVENTION AND OUTCOME A treatment plan aimed at restoring normal thoracic and rib joint movement and decreasing inflammation of the chondrosternal joints resulted in lower pain levels. Treatment consisted of diversified high-velocity, low-amplitude chiropractic manipulation; activator technique; and cryotherapy. CONCLUSION Chiropractic management of Tietze syndrome was successful in reducing pain levels in this patient's case.
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Abstract
This article describes some of the miscellaneous etiologies of pediatric chest pain that are important to recognize early and diagnose. Up to 45% of pediatric chest pain cases may elude definitive diagnosis. Serious morbidity or mortality is infrequent. Accurate diagnosis of more obscure causes may help to avoid unnecessary emergency department evaluation and cardiology referral, while also alleviating the concern and stress families and patients experience when dealing with chest pain.
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Affiliation(s)
- Stephen John Cico
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, M/S B-5520, 4800 Sand Point Way North East, Seattle, WA 98105, USA.
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