Barranco-Trabi Javier, Mank Victoria, Roberts Jefferson, Newman David P
Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA.
Department of Rheumatology, Tripler Army Medical Center, Honolulu, USA.
Cureus. 2021 Apr 8;13(4):e14369. doi: 10.7759/cureus.14369.
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.
肋软骨炎是一种自限性、描述不详的良性病症，通常表现为非心脏性胸痛。症状通常在几周内趋于缓解。在诊断肋软骨炎之前，应排除胸痛的严重病因，因为它往往是一种排除性诊断。不能自行缓解的肋软骨炎被称为非典型肋软骨炎，会给患者带来高额医疗费用和心理负担。在本报告中，我们讨论了一名37岁健康男性患者的病例，该患者有两年沿右前外侧胸廓间歇性疼痛的病史，无任何外伤史。在心脏病学和胃肠病学进行广泛诊断检查后，物理医学与康复科（PM&R）介入。鉴于病程、局灶性压痛的体格检查结果以及正常的实验室值、心电图和影像学检查，最初的胸痛诊断演变为非典型肋软骨炎。对该患者采用了多模式治疗方法，包括手法治疗以确定是否存在区域相互依存关系，随后进行器械辅助软组织松动术（IASTM）和拉伸，以解决潜在的肌筋膜疼痛源。经过三次就诊，晨痛完全缓解，检查时无疼痛。该病例突出了整骨手法技术（OMT）在治疗肋骨功能障碍，特别是非典型肋软骨炎方面的作用。需要进一步研究以扩展我们对肋软骨炎和物理治疗（PT）技术的认识，从而能够早期识别并有效治疗该病症。
