Right rib pain and neck and upper back pain

This 23-year-old female presents today for initial evaluation regarding chronic pain which she has been experiencing in her right rib, neck, and upper back. The patient admits to falling on a log on her stomach in February 2015 while performing an obstacle course. The patient states that she jumped and got a grip of a bar when her hand slipped and she landed on her stomach on the log. A few days later, the patient had a kidney infection on the right, so she was unsure if the pain was coming from the fall or the kidney infection. The patient treated for the kidney infection. She states that her pain symptomatology decreased; however, in July, she started training for a half marathon and she started experiencing exacerbation of symptoms. The patient completed the half marathon in October and she states that her symptomatology has worsened since. The patient admits to a motor vehicle accident in September 2015 when she hit a parked vehicle and there was extensive damage to the front end of the patient’s car. The patient denies treating for the motor vehicle accident. She did have treatment for her rib with a chiropractor and she was receiving adjustments to the rib in the month of October. She states that x-rays were taking and she remembers the chiropractor saying that when her ribs were displaced, however, no fracture was noted.

The patient describes her right rib pain as constant, achy, soreness, tenderness pain which gets worse after taking a deep breath, running or sitting for prolonged periods of time. She describes her neck and upper back pain as constant, tension, and tightness without any symptoms into her upper extremities, denying numbness, tingling, or weakness.

1. Right rib sprain/strain.
2. Intercostal pain.
3. Contusion of the right rib.
4. Possible rib displacement and/or fracture.
5. Muscle spasm, cervicothoracic.
6. Cervical joint dysfunction.
7. Thoracic joint dysfunction.
8. Forward head posture.
9. Winging of the left scapula.
10. Possible scoliosis.

Goals of Treatment:
Short-term goals: (1-8 wks)
1. Decrease Ms spasm and myofascial hypertonicity focusing on upper trapezius musculature, scalenes, paraspinals, and parascapular region.
2. Decrease tenderness and tightness with pain in cervicothoracic and right rib.
3. Improve posture/body mechanics focusing on forward head posture, winging of the scapula, and shoulder discrepancy.
Long-term goals: (8 wks)
1. Progress into strengthening of core muscle groups as tolerated.
2. Teach Home exercise program and patient to become independent with use.
3. Maximize function.

Treatment Plan:
1. Physical medicine and rehabilitation therapy directed at the cervicothoracic and right rib.
2. Include passive modalities of electrical muscle stimulation, manual therapy to the cervical spine only at this time, ultrasound of the right rib, and myofascial release.
3. Rehabilitation and therapeutic exercises and activities to be initiated progressing into corrective phase once tolerated.
4. X-rays of the cervicothoracic and ribs to be performed to assess bony pathology and rule out fracture.
The patient is to follow up in four weeks or sooner if change or worsening in condition as needed.


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