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Sternocostal Pain and Soreness
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Sternocostal Pain and Soreness - March 27, 2003 6:44:00 AM
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VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
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Hi everybody,
This will be my first post. I have been looking for a good PT forum for some time now and I think that I finally found one. I am a brand new PT and I'm always looking for input on new techniques and interventions. I have been lurking for a few days and this forum looks like it has a lot to offer with a lot of smart PT's to share info with.
My question is about sternocostal discomfort. I have a pt that c/o right sternalcostal pain around his 3rd and 4th ribs. The pain is of unknown origin but he has a sneaking suspicion that it may have been caused by some overzelous gym activities. Activities that increase his discomfort mostly are those that involve pectoral exercises such as dips and chest chest presses. Palpation is very tender.
I am a little stumped on my treatment options. I considered modalities such as ionto and phono but I am concerned with the location being so close to the heart. I have considered deep tissue massage, sternocostal mobs (not sure on the effectivness of sternal mobs. I never learned about them in school) and pectoral stretching as well. I am hoping that there is some other treatment other than rest, ice and activity modification.
Any help would be greatly appreciated. Thanks
Dan PT
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Re: Sternocostal Pain and Soreness - March 27, 2003 4:17:00 PM
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touchiba
Posts: 101
Joined: November 11, 2002
From: PA
Status: offline
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Perhaps some pec minor trigger point therapy and stretching may help.
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Re: Sternocostal Pain and Soreness - March 28, 2003 3:31:00 AM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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It is good to see BackTalk mention costochondritis, which is usually underdiagnosed, and there is not much in the literature regarding it. I remember 10 years ago trying to perform a literature search at Pitt on the topic, only to find that most of the studies done were Eastern European and were in Russian!
Most likely a microtear injury to the pec, either major or minor, but should be handled properly to avoid becomeing a full tear/disruption, which is a real hassle.
Definite soft tissue work, pec stretches, pec minor stretches done manually via contract relax techniques ( I have some pics of these, but don't know how to post on this forum), and begin some painfree, light submax isometrics. Rib cage and costovertebral mobilization would be warranted if deficits found, and even poor posture improvement to prevent cage compression is suggested.
I wouldn't worry about the heart with the iontophoresis, being only in mA. I remember having a patient with severe pec atrophy due to cervical HNP, and a whole practice of cardiologists told me that I could perform NMES to the pec with no worry of disruption.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Sternocostal Pain and Soreness - March 28, 2003 5:23:00 AM
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VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
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Great responses everybody
Thanks Backtalk for helping with the diagnosis. I hadn't thought of Glucosamine yet. It sounds like a good reccomendation.
PTupdate. I'm glad to hear that ionto should be alright. I was thinking the same thing as I was planning his treatment. mA really shoulden't disrupt much. HOw about US over the pectorals? any input? Maybe a 3mHz or 5 mhz soundhead?
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Re: Sternocostal Pain and Soreness - March 29, 2003 12:20:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
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Costochondritis is actually a diagnosis of exclusion, and quite often overdiagnosed! As an ED doctor, I see non cardiac chest pain several, several times a day. If one is absolutely sure of the non cardiac and non pleural nature of the pain, then take the costochondritis approach...which I have diagnosed more frequently in outpatient clinics. The idea of DOMS from exercise is true also...so in other words, I only diagnose costochondritis when everything else has been ruled out.
The standard treatment is NSAIDS which ever you wish to try (ibuprofen, naprosyn, celebrex etc)...and I have performed rib manipulation in the ED as well (I am a D.O.).
My advice is to take everything into account, and if the pain persists or worsens, or becomes worrisome...see your doctor.
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Re: Sternocostal Pain and Soreness - March 29, 2003 4:09:00 AM
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Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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VagusX,
As you start out, do your best to avoid mistakes that I made early on, along with many of our colleagues. Cases like this that involve driven exercisers who "overdo it", often involve the patient returning to the exercise before they are ready (against your recommendations of course), thus resulting in perpetuation of symptoms. Do your best to ask extremely detailed questions regarding whether or not this patient is truly resting from all aggravating activities. This is often not stressed enough, and can lead to frustration as to why they dont get better. Dont be afraid to delve deeply into your subjective re-interviews, it will save you loads of time later.
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Re: Sternocostal Pain and Soreness - March 29, 2003 4:57:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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VagusX,
I wouldn't do US over the pectorals or heart, as it just would not be worth the risk. While we have all argued as to whether US even does anything therapeutic, we most likely all aggree that US can certainly cause some damage.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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