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Kubrova E, Hallo-Carrasco AJ, Klasova J, Pagan Rosado RD, Prusinski CC, Trofymenko O, Schappell JB, Prokop LJ, Yuh CI, Gupta S, Hunt CL. Persistent chest pain following COVID-19 infection - A scoping review. PM R 2024; 16:605-625. [PMID: 37906499 DOI: 10.1002/pmrj.13098] [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: 05/17/2023] [Revised: 10/07/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
Persistent chest pain (PCP) following acute COVID-19 infection is a commonly reported symptom with an unclear etiology, making its management challenging. This scoping review aims to address the knowledge gap surrounding the characteristics of PCP following COVID-19, its causes, and potential treatments. This is a scoping review of 64 studies, including observational (prospective, retrospective, cross-sectional, case series, and case-control) and one quasi-experimental study, from databases including Embase, PubMed/MEDLINE, Cochrane CENTRAL, Google Scholar, Cochrane Database of Systematic Reviews, and Scopus. Studies on patients with PCP following mild, moderate, and severe COVID-19 infection were included. Studies with patients of any age, with chest pain that persisted following acute COVID-19 disease, irrespective of etiology or duration were included. A total of 35 studies reported PCP symptoms following COVID-19 (0.24%-76.6%) at an average follow-up of 3 months or longer, 12 studies at 1-3 months and 17 studies at less than 1-month follow-up or not specified. PCP was common following mild-severe COVID-19 infection, and etiology was mostly not reported. Fourteen studies proposed potential etiologies including endothelial dysfunction, cardiac ischemia, vasospasm, myocarditis, cardiac arrhythmia, pneumonia, pulmonary embolism, postural tachycardia syndrome, or noted cardiac MRI (cMRI) changes. Evaluation methods included common cardiopulmonary tests, as well as less common tests such as flow-mediated dilatation, cMRI, single-photon emission computed tomography myocardial perfusion imaging, and cardiopulmonary exercise testing. Only one study reported a specific treatment (sulodexide). PCP is a prevalent symptom following COVID-19 infection, with various proposed etiologies. Further research is needed to establish a better understanding of the causes and to develop targeted treatments for PCP following COVID-19.
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Affiliation(s)
- Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Johana Klasova
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert D Pagan Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | | | - Larry J Prokop
- Library and Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Clara I Yuh
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, California, USA
| | - Sahil Gupta
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Christine L Hunt
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Tomesch AJ, Negaard M, Keller-Baruch O. Chest and Thorax Injuries in Athletes. Clin Sports Med 2023; 42:385-400. [PMID: 37208054 DOI: 10.1016/j.csm.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Injuries to the chest and thorax are rare, but when they occur, they can be life-threatening. It is important to have a high index of suspicion to be able to make these diagnoses when evaluating a patient with a chest injury. Often, sideline management is limited and immediate transport to a hospital is indicated.
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Affiliation(s)
- Alexander J Tomesch
- Department of Emergency Medicine, University of Missouri, Columbia, MO, USA.
| | - Matthew Negaard
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA. https://twitter.com/MattNegaard
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Park J, Kim SJ, Kim H, Jung H, Shin HY. Ultrasound diagnosis and treatment of intractable anterior chest pain from golf - A case report. Anesth Pain Med (Seoul) 2023; 18:65-69. [PMID: 36746904 PMCID: PMC9902635 DOI: 10.17085/apm.22182] [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] [Received: 05/26/2022] [Accepted: 10/31/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pleurisy is an inflammation of the parietal pleura and is characterized by pleuritic pain. The most common cause of pleurisy is infection; other causes include rheumatoidarthritis, malignancy, rib fractures, or trauma. Possible causes of chest pain associated withgolf include costochondritis, stress fractures of the ribs, intercostal muscle strain, or, rarely,Tietze's syndrome and slipping rib syndrome. CASE A 64-year-old female presented with intractable chest pain that began 4 months priorwhile playing golf. No specific cause was found after various examinations. There was persistent pain despite medical treatment. Ultrasonography (US) was performed over the painful areas, which revealed focal pleural effusions. A mixture of ropivacaine and triamcinolonewas injected into the focal pleural effusions using US guidance, which dramatically relievedher pain. CONCLUSIONS This case demonstrates that US can be used as a diagnostic and therapeuticmodality for intractable chest pain with an undetected pathology.
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Affiliation(s)
- Jihye Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyunho Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Haesun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hwa Yong Shin
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea,Corresponding author Hwa Yong Shin, M.D., Ph.D., FIPP, CIPS Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: 82-2-6299-3164 Fax: 82-2-6299-2585 E-mail:
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Articular Findings on Chest Computed Tomography: An Algorithmic Approach for Radiologists. J Comput Assist Tomogr 2022; 46:914-922. [PMID: 36055107 DOI: 10.1097/rct.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chest computed tomography (CT) is one of the most frequently performed imaging studies. Incidental osseous and articular findings are commonly encountered in chest CTs in daily practice. The spectrum of findings is broad, varying from benign to malignant, and interpretation of these incidental musculoskeletal findings could be challenging for radiologists. In this review, we provide a systematic algorithmic approach for the diagnosis of common articular findings seen on chest CT with recommendations for appropriate follow-up evaluation.
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Non-Cardiac Conditions that Mimic Cardiac Symptoms in Athletes. Clin Sports Med 2022; 41:389-404. [PMID: 35710268 DOI: 10.1016/j.csm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When considering the variety of complaints an athlete can present with, chest pain is arguably the most concerning given the potential for catastrophic outcomes. Luckily, these do not comprise the majority of cases, and indeed, are quite rare. The bulk of presentations of athletes with chest pain are due to musculoskeletal, gastrointestinal, and pulmonary causes. Each and every healthcare provider who works closely with athletes must have a thorough understanding of contributing conditions that present as chest pain. Here, we explore some of the more prevalent causes of non-cardiac chest pain, classic presentations, and management considerations.
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Ahmad Adni LL, Norhayati MN, Mohd Rosli RR, Muhammad J. A Systematic Review and Meta-Analysis of the Efficacy of Evening Primrose Oil for Mastalgia Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126295. [PMID: 34200727 PMCID: PMC8296106 DOI: 10.3390/ijerph18126295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
Mastalgia, or breast pain, is common among women which can lead to significant impairment in daily living. Hence, finding an effective treatment that can alleviate the symptom is very important. Thus, we carry out this study to determine the efficacy of evening primrose oil (EPO) for mastalgia treatment in women. The review included published randomised clinical trials that evaluated EPO used for treating mastalgia against a placebo or other treatments, irrespective of the blinding procedure, publication status, or sample size. Two independent authors screened the titles and abstracts of the identified trials; full texts of relevant trials were evaluated for eligibility. Two reviewers independently extracted data on the methods, interventions, outcomes, and risk of bias. The random-effects model was used for estimating the risk ratios and mean differences with 95% confidence intervals. Thirteen trials with 1752 randomised patients were included. The results showed that EPO has no difference to reduce breast pain compared to topical NSAIDS, danazol, or vitamin E. The number of patients who achieved pain relief was no different compared to the placebo or other treatments. The EPO does not increase adverse events, such as nausea, abdominal bloating, headache or giddiness, increase weight gain, and altered taste compared to a placebo or other treatments. EPO is a safe medication with similar efficacy for pain control in women with mastalgia compared to a placebo, topical NSAIDS, danazol, or vitamin E.
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Abstract
ABSTRACT Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.
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Affiliation(s)
- Alexandra Gundersen
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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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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(Examination of the musculoskeletal system of an athlete with a focus on cardiorespiratory problems). COR ET VASA 2020. [DOI: 10.33678/cor.2020.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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A Case Series and Literature Review: Isolated Traumatic First Rib Fracture in Athletes. Clin J Sport Med 2020; 30:257-266. [PMID: 30015636 DOI: 10.1097/jsm.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present a case series of 14 isolated traumatic first rib fractures sustained in sport and review the literature on clinical presentation, mechanism of injury, diagnosis, and management of sport-related traumatic first rib fractures. DESIGN We compiled a series of isolated traumatic first rib fractures seen in 2 Division 1-associated sports medicine clinics. We also performed a literature search for additional publications of isolated traumatic first rib fractures in sport. SETTING Patients in our case series were all evaluated and treated at 2 tertiary care center sports medicine clinics. PATIENTS Patients were those who sustained isolated traumatic first rib fracture during sport. INTERVENTIONS None. MAIN OUTCOME MEASURES None. RESULTS None. CONCLUSIONS Traumatic fracture of the first rib in sport is certainly not a common diagnosis, but it is likely more widespread than sports medicine providers realize. Considering the diagnosis of first rib fracture for athletes with shoulder pain after trauma is essential for identifying this injury. Although more study is likely needed to make definitive recommendations on treatment and return to play protocols, the case series and literature review presented suggests that rehabilitation and return to play when the patient is asymptomatic may be appropriate care.
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Mazzella A, Fournel L, Bobbio A, Janet-Vendroux A, Lococo F, Hamelin EC, Icard P, Alifano M. Costal cartilage resection for the treatment of slipping rib syndrome (Cyriax syndrome) in adults. J Thorac Dis 2020; 12:10-16. [PMID: 32055418 DOI: 10.21037/jtd.2019.07.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Slipping rib syndrome is an overlooked cause of low chest or upper abdominal pain. Costal cartilage excision has been described as an effective treatment of this disorder. We review our experience with surgically treated slipping rib syndrome in the adult patient. Methods This is a single institution retrospective analysis from January 2000 to March 2019 of adult patients operated on for treatment of a slipping rib syndrome. Results Nineteen patients were diagnosed with slipping rib syndrome and underwent costal cartilage excision. All patients presented with unilateral and life disturbing chest pain (8 left sided). In all cases, point tenderness was observed with palpation and hooking maneuver was positive. Each patient underwent imaging and ultrasonography suggested slipping rib syndrome in one case. A mean of 1±0.2 cartilages was excised. Early postoperative course was uneventful in all the cases. Follow-up was complete for all patients over a median of 18.7±12 [3-132] months. At postoperative month 2 follow-up, 15 on 19 patients had complete resolution of their symptoms. At late interviews, 6 out of 19 patients described recurrent pain, whose intensity was significantly lower. We observed significant differences about pre-operative and post-operative visual analog pain (EVA) (8.07±0.75 vs. 2±2.3, P<0.005), weekly pain crises (6.25±2.7 vs. 1.6±2.1, P<0.005) and morphinics consomption (9/19 vs. 2/19, P=0.029). Fourteen patients out of 19 nineteen strongly recommended surgical intervention. Conclusions Slipping rib syndrome of the adult is an overlooked cause of chest or abdominal pain which diagnosis and treatment are often delayed. Costal cartilage excision allows short to mid-terms effective and reliable treatment to reduce symptoms and life disturbance but does not exclude late pain recurrence.
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Affiliation(s)
- Antonio Mazzella
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Ludovic Fournel
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Antonio Bobbio
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Aurélie Janet-Vendroux
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Filippo Lococo
- Department of Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emelyne Canny Hamelin
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Philippe Icard
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Marco Alifano
- Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
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Anatomy. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Abstract
Objectives:
The objective of this study was to study the results of the largest prospective series to date of xiphodynia patients treated by surgical xiphoidectomy.
Summary of Background Data:
Xiphodynia is a condition of recurrent and often debilitating severe upper abdominal or sternal chest pain. A retrospective analysis was conducted of 40 patients undergoing xiphoidectomy from January 2014 to January 2017.
Methods:
Preoperative and postoperative pain scales were measured, by using a standardized Wong-Baker visual pain scale, with a reported zero as no pain and 10 as worse pain. Statistical analysis of pre- and post-operative pain scale were recorded and statistical analysis completed by using a nonparametric Mann–Whitney U. The preoperative pain scale for the patient's ranged from the level of 9 to 10 (mean: 9.9).
Results:
The postoperative pain scale was rated between zero and 2 (mean: <1). There was a significant improvement in pain rating from preoperative to postoperative with a P > 0.024. All of the sports injury patients (n = 9) were back to full activity 4 to 6 weeks after the procedure.
Conclusions:
Xiphoidectomy can be an appropriate treatment modality for intractable cases of severe xiphodynia after failure of more conservative treatments. Patients with recurrence of severe, disabling pain and disability appear to benefit the most from a surgical approach based on the results of this study.
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Kerr H, Bowen B, Light D. Thoracoabdominal Injuries. CONTEMPORARY PEDIATRIC AND ADOLESCENT SPORTS MEDICINE 2018. [PMCID: PMC7123492 DOI: 10.1007/978-3-319-56188-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma to the thorax and abdomen can occur during participation in sports. This chapter reviews some of the more common presentations of such injuries and how such injuries should be best managed. Thoracic injuries reviewed include internal injuries such as pneumothorax, pulmonary contusion, hemothorax, commotio cordis, and cardiac contusion. Chest wall injuries are also reviewed such as rib fractures, costochondritis, and slipping rib syndrome plus sternal and scapular fractures. Abdominal injuries reviewed are focused on internal organ trauma to the spleen and liver, kidney, pancreas, and bowel. There is attention to the effect of Epstein-Barr virus and infectious mononucleosis, seen very frequently in high school and collegiate athletes. Finally, groin pain and athletic pubalgia are described. In addition to anatomy and clinical presentation, imaging modalities that characterize such trauma are reviewed for each diagnosis. Prevention of thoracoabdominal injuries and return-to-play decisions are described at the chapter conclusion.
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Stress rib fracture in an amateur golfer. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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. 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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Chest Pain From Hypermobility Responding to Physical Therapy in an Adolescent. Am J Phys Med Rehabil 2017; 96:e219-e222. [PMID: 28272092 DOI: 10.1097/phm.0000000000000734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypermobility syndrome usually causes pain in limbs from extension type injuries. The authors report on a 16-yr-old female adolescent with incapacitating chest pain secondary to extreme hypermobility of the chest. This pain led the patient to see multiple specialists without improvement or diagnosis. Physical examination results revealed a very hypermobile patient who was able to internally rotate her shoulders inward until her elbows touched. This unusual hyperextension maneuver was achieved by holding the shoulders in anteversion with her hands on her hips (see figures in the article). Currently, there is no literature reporting hypermobility as a cause for chronic chest pain. Pain medication including opioids did not reduce the patient's chronic chest pain. Specific physical therapy to strengthen core and chest wall muscles in addition to working on proper breathing techniques with the diaphragm decreased pain and resulted in a resolution of this condition. We report that hypermobility can cause significant chest pain and may require creative physical therapy to strengthen the specific musculature.
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Roston AT, Wilkinson M, Forster BB. Imaging of rib stress fractures in elite rowers: the promise of ultrasound? Br J Sports Med 2017; 51:1093-1097. [DOI: 10.1136/bjsports-2016-096989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/03/2022]
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Abstract
Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.
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Affiliation(s)
- Brayden J Gerrie
- a Houston Methodist Orthopedics & Sports Medicine , Houston Methodist Hospital , Houston , TX , USA
| | - Joshua D Harris
- a Houston Methodist Orthopedics & Sports Medicine , Houston Methodist Hospital , Houston , TX , USA
| | - David M Lintner
- a Houston Methodist Orthopedics & Sports Medicine , Houston Methodist Hospital , Houston , TX , USA
| | - Patrick C McCulloch
- a Houston Methodist Orthopedics & Sports Medicine , Houston Methodist Hospital , Houston , TX , USA
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Kato K, Yabuki S, Otani K, Nikaido T, Otoshi KI, Watanabe K, Kikuchi SI, Konno SI. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher. Fukushima J Med Sci 2016; 62:64-7. [PMID: 26983590 DOI: 10.5387/fms.2015-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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McAdams TR, Deimel JF, Ferguson J, Beamer BS, Beaulieu CF. Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians. Orthop J Sports Med 2016; 4:2325967115627623. [PMID: 26925425 PMCID: PMC4753355 DOI: 10.1177/2325967115627623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although a recognized and discussed injury, chondral rib fractures in professional American football have not been previously reported in the literature. There currently exists no consensus on how to identify and treat these injuries or the expected return to play for the athlete. PURPOSE To present 2 cases of chondral rib injuries in the National Football League (NFL) and discuss the current practice patterns for management of these injuries among the NFL team physicians. STUDY DESIGN Case series; Level of evidence, 4. METHODS Two cases of NFL players with chondral rib injuries are presented. A survey regarding work-up and treatment of these injuries was completed by team physicians at the 2014 NFL Combine. Our experience in identifying and treating these injuries is presented in conjunction with a survey of NFL team physicians' experiences. RESULTS Two cases of rib chondral injuries were diagnosed by computed tomography (CT) and treated with rest and protective splinting. Return to play was 2 to 4 weeks. NFL Combine survey results show that NFL team physicians see a mean of 4 costal cartilage injuries per 5-year period, or approximately 1 case per year per team. Seventy percent of team physicians use CT scanning and 43% use magnetic resonance imaging for diagnosis of these injuries. An anesthetic block is used acutely in 57% and only electively in subsequent games by 39%. CONCLUSION A high index of suspicion is necessary to diagnose chondral rib injuries in American football. CT scan is most commonly used to confirm diagnosis. Return to play can take up to 2 to 4 weeks with a protective device, although anesthetic blocks can be used to potentially expedite return. CLINICAL RELEVANCE Chondral rib injuries are common among NFL football players, while there is no literature to support proper diagnosis and treatment of these injuries or expected duration of recovery. These injuries are likely common in other contact sports and levels of competition as well. Our series combined with NFL team physician survey results can aid team physicians in identifying these injuries, obtaining useful imaging, and counseling players and coaches and the expected time of recovery.
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Affiliation(s)
- Timothy R McAdams
- Department of Orthopedic Surgery, Sports Medicine, Stanford University, Stanford, California, USA
| | - Jay F Deimel
- Illinois Bone and Joint Institute, Chicago, Illinois, USA
| | | | - Brandon S Beamer
- Stanford Sports Medicine, Stanford University, Stanford, California, USA
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Zbojniewicz AM. US for diagnosis of musculoskeletal conditions in the young athlete: emphasis on dynamic assessment. Radiographics 2015; 34:1145-62. [PMID: 25208273 DOI: 10.1148/rg.345130151] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) is increasingly recognized as an important tool for diagnosis and therapeutic management of a variety of musculoskeletal conditions. Advantages of US use in the young athlete include the ability to diagnose dynamic conditions that are occult with other modalities, provide additional diagnostic information, and aid in treatment. Uses of US in young patients include evaluation of acquired musculoskeletal conditions that manifest with symptoms and assessment of congenital variants that may manifest with pain or limitations in activity. Acquired conditions in the young athlete include tendon disorders, such as proximal tendinosis, and ligament disorders, such as anterior talofibular ligament or ulnar collateral ligament tears. While static images are frequently able to depict these disorders without difficulty, a dynamic examination that provides stress to the joint of interest may be able to uncover a ligament tear or insufficiency and concurrently provide the clinician with information regarding joint stability. Numerous congenital variants that occur throughout the musculoskeletal system can be associated with awkward sensations such as snapping, popping, and clunking and occasionally with pain. Pathologic processes associated with congenital variants in the upper extremities include slipping rib syndrome, atraumatic anterior subluxation of the sternoclavicular joint, and snapping triceps syndrome. Conditions that affect the lower extremities include internal and external snapping hip syndrome, snapping knee syndrome, and medial plica syndrome. The dynamic capability of US is ideal for diagnosis of many conditions that affect the musculoskeletal system of the young athlete, many of which would be difficult or impossible to identify with use of other imaging modalities.
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Affiliation(s)
- Andrew M Zbojniewicz
- From the Division of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229
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Bolaños-Vergaray JJ, de la Gala García F, Obaya Rebollar JC, Bové Alvarez M. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain. ACTA ACUST UNITED AC 2015; 5:167-8. [DOI: 10.1213/xaa.0000000000000243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Chest Pain in Athletes from Personal History Section (Musculoskeletal Causes). Curr Sports Med Rep 2015; 14:252-4. [DOI: 10.1097/01.csmr.0000465135.63122.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Collins SA, Griksaitis MJ, Legg JP. 15-minute consultation: a structured approach to the assessment of chest pain in a child. Arch Dis Child Educ Pract Ed 2014; 99:122-6. [PMID: 24301714 DOI: 10.1136/archdischild-2013-303919] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article aims to provide a concise, structured approach to the child with chest pain. Chest pain is a common presenting symptom in children but, unlike in adults, the cause is rarely cardiac. We review the main causes of chest pain in children and discuss the important features that may alert those assessing paediatric chest pain to serious underlying pathology. In the vast majority of cases, reassurance is all that is required and a thorough initial consultation can exclude rare, serious disease and provide vital reassurance to children and families.
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Affiliation(s)
- Samuel A Collins
- Department of Paediatric Respiratory Medicine, Southampton Children's Hospital, Southampton, UK
| | - Michael J Griksaitis
- Department of Paediatric Intensive Care, Southampton Children's Hospital, Southampton, UK
| | - Julian P Legg
- Department of Paediatric Respiratory Medicine, Southampton Children's Hospital, Southampton, UK National Institute of Health Research Biomedical Research Unit in Respiratory Disease, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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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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Abstract
Costal cartilage fracture of the rib cage, or costochondral, is a rare sporting injury. For contact athletes, the instability of the rib cage may lead to potential serious complications, similar to rib fractures or thorax disruption. Most authors recommend initial conservative treatment with surgery reserved for only recalcitrant cases. We report a case of an amateur American male rugby football player who sustained a costal cartilage fracture and disruption involving the anterior left fifth and sixth rib costal cartilages. The case highlights the difficulty in establishing the diagnosis based on clinical examination and standard radiographs alone. Computed tomography was used to assist in diagnosing this destabilizing injury to the rib cage. Costal cartilage fractures and disruptions in athletes are rarely reported in the literature and can have serious implications for the athlete's ability to return to play if the rib cage is destabilized.
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Fu R, Iqbal CW, Jaroszewski DE, St Peter SD. Costal cartilage excision for the treatment of pediatric slipping rib syndrome. J Pediatr Surg 2012; 47:1825-7. [PMID: 23084191 DOI: 10.1016/j.jpedsurg.2012.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/01/2012] [Accepted: 06/03/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Costal cartilage excision is an effective treatment of slipping rib syndrome (SRS), although the diagnosis of SRS may be elusive. We review our experience with SRS in the pediatric patient. METHODS This is a retrospective review from 2000 to 2011 of patients presenting with symptoms of SRS before 18 years of age. RESULTS Seven patients were identified who were diagnosed with SRS and underwent costal cartilage excision. All patients presented with unilateral chest pain that was exacerbated by activity. Five patients reported a popping or clicking sensation with activity that was associated with pain. On physical examination, all patients had reproducible pain with palpation over the affected cartilage. Four patients had a mobile or popping rib with palpation, and 4 also had chest wall asymmetry. Five patients underwent imaging, and 4 patients were referred to specialists. It was a median of 2 years (0-5 years) from onset of symptoms to resection. At resection, all cartilages were grossly abnormal. There were no postoperative complications. Follow-up was complete for all patients over a median 0.9 years (0.2-2.0 years). One patient had recurrence of pain in a different location; another had persistent pain, which was less severe. CONCLUSIONS Slipping rib syndrome presents with costal cartilage pain that is reproducible on physical examination and commonly associated with a mobile rib. Excision of the affected cartilage(s) is an effective treatment and should be considered early to avoid unnecessary diagnostic tests and evaluation, which delay definitive therapy.
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Affiliation(s)
- Roxana Fu
- Department of Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ 85054, USA
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Wild AT, Begly JP, Garzon-Muvdi J, Desai P, McFarland EG. First-rib stress fracture in a high-school lacrosse player: a case report and short clinical review. Sports Health 2012; 3:547-9. [PMID: 23016057 PMCID: PMC3445230 DOI: 10.1177/1941738111416189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A 14-year-old right-hand dominant female lacrosse player presented with a complaint of right shoulder and upper posterior thorax pain of 8 days' duration. She had been playing lacrosse at the attack wing and midfielder positions and experienced insidious pain after a game. She had no history of trauma to that shoulder during that game and had not experienced an injury in the past. Six days after the pain developed, she woke up one night with a sudden increase in the pain, which brought her to tears and caused slight difficulty with breathing. The pain was located anteriorly just lateral to the right sternoclavicular joint and posteriorly in the paraspinal muscles in the upper thoracic region. Physical examination suggested a first-rib stress fracture, which was subsequently confirmed by chest and shoulder radiographs.
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Affiliation(s)
- Aaron T Wild
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Abstract
Rowing injuries occur mostly from overuse and are seen primarily in the back, rib, knee, and forearm. Many of these have a specific cause owing to the mechanics of the rowing stroke, which are discussed, as are sport-specific treatment strategies. Also discussed are specific injuries sustained on the rowing machine, emergency issues, and special population concerns.
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Affiliation(s)
- Kristine A Karlson
- Department of Community and Family Medicine and Orthopaedics, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, NH 03756, USA.
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34
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Conte SA, Thompson MM, Marks MA, Dines JS. Abdominal muscle strains in professional baseball: 1991-2010. Am J Sports Med 2012; 40:650-6. [PMID: 22268233 DOI: 10.1177/0363546511433030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The abdominal core muscles (internal and external oblique, rectus and transversus abdominis) play an important role in the baseball activities of pitching and hitting. Proper abdominal muscle activation during throwing and swinging is crucial for generating optimal ball velocity and bat speed. Abdominal muscle strains can result in substantial loss of playing time, and their incidence has never been reported in baseball. HYPOTHESIS The incidence of abdominal muscle strains in Major League Baseball has been rising over the past 20 years. Injuries contralateral to the dominant arm or batting side are more common and require more time to recover. STUDY DESIGN Descriptive epidemiology study. METHODS Abdominal muscle strains in baseball players were determined by retrospective review of the Major League Baseball disabled list from 1991 to 2010. Player age, position, dominant hand, batting side, and recovery time were recorded. RESULTS There were 393 abdominal muscle strains in Major League Baseball from 1991 to 2010, constituting 5% of all baseball injuries. At least 92% of these injuries were internal/external oblique or intercostal muscle strains, and 44% of injuries were sustained by pitchers. The reinjury rate was 12.1%. An upward trend was seen from 1991 to 2010, especially in early-season injuries, and the overall injury rate was 22% higher in the 2000s than in the 1990s. Pitchers averaged 35.4 days on the disabled list compared with 26.7 days for position players (P < .01); 78.1% of pitcher injuries were contralateral to their dominant arm, and 70.3% of position player injuries were contralateral to their dominant batting side (excluding switch hitters). Position players missed more time for contralateral than for ipsilateral injuries (28.9 vs 21.2 days, P = .03), whereas pitchers missed more time for ipsilateral injuries (44.5 vs 32.8 days, P = .04). CONCLUSION The incidence of abdominal muscle strains in baseball has been increasing over the past 20 years, especially early in the season, and there is a relatively high reinjury rate. This upward trend is in spite of new and more advanced diagnostic procedures, preventive core strengthening exercise programs, and rehabilitation techniques. Injuries contralateral to the dominant arm or batting side are more common.
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Affiliation(s)
- Stan A Conte
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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McDonnell LK, Hume PA, Nolte V. Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies. Sports Med 2012; 41:883-901. [PMID: 21985212 DOI: 10.2165/11593170-000000000-00000] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rib stress fractures (RSFs) can have serious effects on rowing training and performance and accordingly represent an important topic for sports medicine practitioners. Therefore, the aim of this review is to outline the definition, epidemiology, mechanisms, intrinsic and extrinsic risk factors, injury management and injury prevention strategies for RSF in rowers. To this end, nine relevant books, 140 journal articles, the proceedings of five conferences and two unpublished presentations were reviewed after searches of electronic databases using the keywords 'rowing', 'rib', 'stress fracture', 'injury', 'mechanics' and 'kinetics'. The review showed that RSF is an incomplete fracture occurring from an imbalance between the rate of bone resorption and the rate of bone formation. RSF occurs in 8.1-16.4% of elite rowers, 2% of university rowers and 1% of junior elite rowers. Approximately 86% of rowing RSF cases with known locations occur in ribs four to eight, mostly along the anterolateral/lateral rib cage. Elite rowers are more likely to experience RSF than nonelite rowers. Injury occurrence is equal among sweep rowers and scullers, but the regional location of the injury differs. The mechanism of injury is multifactorial with numerous intrinsic and extrinsic risk factors contributing. Posterior-directed resultant forces arising from the forward directed force vector through the arms to the oar handle in combination with the force vector induced by the scapula retractors during mid-drive, or repetitive stress from the external obliques and rectus abdominis in the 'finish' position, may be responsible for RSF. Joint hypomobility, vertebral malalignment or low bone mineral density may be associated with RSF. Case studies have shown increased risk associated with amenorrhoea, low bone density or poor technique, in combination with increases in training volume. Training volume alone may have less effect on injury than other factors. Large differences in seat and handle velocity, sequential movement patterns, higher elbow-flexion to knee-extension strength ratios, higher seat-to-handle velocity during the initial drive, or higher shoulder angle excursion may result in RSF. Gearing may indirectly affect rib loading. Increased risk may be due to low calcium, low vitamin D, eating disorders, low testosterone or use of depot medroxyprogesterone injections. Injury management involves 1-2 weeks cessation of rowing with analgesic modalities followed by a slow return to rowing with low-impact intensity and modified pain-free training. Some evidence shows injury prevention strategies should focus on strengthening the serratus anterior, strengthening leg extensors, stretching the lumbar spine, increasing hip joint flexibility, reducing excessive protraction, training with ergometers on slides or floating-head ergometers, and calcium and vitamin D supplementation. Future research should focus on the epidemiology of RSF over 4-year Olympic cycles in elite rowers, the aetiology of the condition, and the effectiveness of RSF prevention strategies for injury incidence and performance in rowing.
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Affiliation(s)
- Lisa K McDonnell
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.
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37
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Heiderscheit B, Boissonnault W. Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymptomatic individuals. J Man Manip Ther 2011; 16:210-6. [PMID: 19771193 DOI: 10.1179/106698108790818369] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Despite the importance of correctly diagnosing a spinal dysfunction, limited research exists related to physical therapists' ability to reliably identify a joint exhibiting signs of dysfunction. The purpose of this investigation was to determine the inter- and intra-examiner reliability of a thoracic spine and rib cage joint mobility and pain assessment between two experienced manipulative physical therapists. Nine healthy subjects (3 male, 6 female; ages 23-35) without history of mid- or low back pain participated. Posterior-to-anterior pressures were applied to the thoracic spine and rib articulations with anterior-to-posterior pressures applied to the costosternal joints of each subject by two examiners to evaluate joint mobility and pain provocation. Both examiners assessed all subjects twice and were blinded to subject identity. Kappa statistics were calculated using a strict and expanded definition of agreement to determine the between- and within-examiner reliability for each outcome. Intra-examiner reliability of joint mobility assessment ranged from slight to fair based on the strict agreement but improved to good when findings were compared across +/- 1 spinal/rib level. Pain provocation reliability increased to very good under the expanded agreement; however, this finding should be viewed with caution due to limited pain prevalence in the subject sample. Selected clinical prediction rules, applied to the care of individuals with back pain, characterize the patient's regional mobility simply as hypomobile, normal, or hypermobile; consequently, we feel the results of an expanded definition of agreement may be more appropriate for clinic practice. Further research is needed to determine the reliability in individuals with thoracic spine and rib cage symptoms.
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Grindstaff TL, Beazell JR, Saliba EN, Ingersoll CD. Treatment of a female collegiate rower with costochondritis: a case report. J Man Manip Ther 2011; 18:64-8. [PMID: 21655387 DOI: 10.1179/106698110x12640740712653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Rib injuries are common in collegiate rowing. The purpose of this case report is to provide insight into examination, evaluation, and treatment of persistent costochondritis in an elite athlete as well as propose an explanation for chronic dysfunction. The case involved a 21 year old female collegiate rower with multiple episodes of costochondritis over a 1-year period of time. Symptoms were localized to the left third costosternal junction and bilaterally at the fourth costosternal junction with moderate swelling. Initial interventions were directed at the costosternal joint, but only mild, temporary relief of symptoms was attained. Reexamination findings included hypomobility of the upper thoracic spine, costovertebral joints, and lateral ribs. Interventions included postural exercises and manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility. Over a 3-week time period pain experienced throughout the day had subsided (visual analog scale - VAS 0/10). She was able to resume running and elliptical aerobic training with minimal discomfort (VAS 2/10) and began to reintegrate into collegiate rowing. Examination of the lateral ribs, cervical and thoracic spine should be part of the comprehensive evaluation of costochondritis. Addressing posterior hypomobility may have allowed for a more thorough recovery in this case study.
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Affiliation(s)
- Terry L Grindstaff
- Curry School of Education and Department of Athletics, University of Virginia, USA
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Deroux A, Maillet M, Dentan C, Bosseray A, Colombe B, Mathieu N, Massot C. Syndrome de la côte glissante ou syndrome de Cyriax. Presse Med 2011; 40:318-9. [DOI: 10.1016/j.lpm.2010.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 11/27/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022] Open
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Abstract
Musculoskeletal chest pain is the most common identifiable cause of chest pain in children and adolescents. A lesion or irritation of any layer of the anterior chest wall may lead to pain. Causes range from the common, such as costochondritis, to the rare, such as chronic recurrent multifocal osteomyelitis. Regardless of the cause, chest pain raises concern of cardiac abnormalities, and may rapidly lead to significant anxiety and lifestyle alterations. Thus, efficient and accurate identification of the cause of pediatric chest pain by a thorough history and physical examination is important to minimize the disruption it may cause.
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Affiliation(s)
- Mary Beth F Son
- Division of Immunology, Harvard Medical School, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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41
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Culp B, Hurbanek JG, Novak J, McCamey KL, Flanigan DC. Acute traumatic sternum fracture in a female college hockey player. Orthopedics 2010; 33:683. [PMID: 20839748 DOI: 10.3928/01477447-20100722-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Brian Culp
- Sports Medicine Center, Department of Orthopedics, The Ohio State University, Columbus, Ohio, USA
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Abstract
BACKGROUND A 54-year-old previously healthy white man presented to hospital with fever, right parasternal pain and swelling over the right second and third costochondral joints. The symptoms had developed 1 week earlier. INVESTIGATIONS Physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, blood and urine culture, plain radiography and CT of the chest, (99m)Tc bone scintigraphy, ultrasound-guided needle aspiration of soft tissue mass, Gram staining and culture of aspirated fluid. DIAGNOSIS Meticillin-sensitive Staphylococcus aureus costochondritis. MANAGEMENT CT revealed a 2 x 5 cm soft tissue mass at the posterior aspect of the right second and third costochondral joints. The fluid aspirated contained Gram-positive cocci, and culture revealed the presence of meticillin-sensitive S. aureus. The patient received a 6-week course of flucloxacillin (2 g by intravenous injection every 6 h for 2 weeks, then 1 g orally every 6 h for 4 weeks). He responded well to treatment, and was discharged from hospital.
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Abstract
Initial management of chest pain in athletes always should involve assessment for serious, life-threatening causes, such as myocardial infarction. However, atypical chest pain, or chest pain not due to myocardial ischaemia, is a common presentation in the athletic population. This review looks at the possible causes of atypical chest pain in athletes, focusing upon conditions that are more common in athletes than the general population or that have a link to exercise. Causes can be grouped due to the system involved (musculoskeletal, gastrointestinal, respiratory, cardiac) with more common causes including rib stress fractures, costochondritis, muscle strain, gastroesophageal reflux, and exercise-induced asthma. Psychogenic causes can be common in children/adolescents. Return to play is discussed, with some conditions such as myocarditis warranting a long (at least 6 months) absence from training, whereas others such as precordial catch require nothing more than reassurance.
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Affiliation(s)
- Emma C Sik
- Centre for Sports Medicine, Queens Medical Centre, Nottingham University Hospitals, United Kingdom.
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45
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Abstract
Sternal fractures are relatively common and range from simple unicortical cracks to displaced fractures associated with life threatening injuries. This paper describes the relevant anatomy, biomechanics, mechanism of injury, clinical presentation, investigation, treatment and complications and also includes associated and concomitant injuries. A management flow chart including criteria for discharge from the emergency department is presented.
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Affiliation(s)
- Rangan Raghunathan
- Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK,
| | - Keith Porter
- Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
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46
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Abstract
A 20-year-old woman elite weightlifter presented with acute onset debilitating right shoulder pain while attempting the "clean and jerk." There was no previous relevant history, including no prior fracture in the region. Examination confirmed vague tenderness in the right supraclavicular fossa with no discernible neurologic or vascular deficit within the right arm. X-ray was normal. The patient had a bone scan, including SPECT, suggesting a fracture of the right first rib, subsequently confirmed on CT examination.
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Bussières AE, Taylor JA, Peterson C. Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach—Part 3: Spinal Disorders. J Manipulative Physiol Ther 2008; 31:33-88. [DOI: 10.1016/j.jmpt.2007.11.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/28/2007] [Accepted: 10/14/2007] [Indexed: 01/29/2023]
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Otoshi KI, Itoh Y, Tsujino A, Hasegawa M, Kikuchi SI. Avulsion injury of the serratus anterior muscle in a high-school underhand pitcher: a case report. J Shoulder Elbow Surg 2007; 16:e45-7. [PMID: 17644009 DOI: 10.1016/j.jse.2006.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 12/04/2006] [Accepted: 12/14/2006] [Indexed: 02/01/2023]
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50
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Aspegren D, Hyde T, Miller M. Conservative Treatment of a Female Collegiate Volleyball Player with Costochondritis. J Manipulative Physiol Ther 2007; 30:321-5. [DOI: 10.1016/j.jmpt.2007.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 01/01/2007] [Accepted: 01/02/2007] [Indexed: 11/29/2022]
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