Patient Information:
Name: Imran Ali
Age: 42 years
Gender: Male
Occupation: Office Manager
Referring Physician: Dr. Sarah Johnson
Presenting Complaints:
Imran Ali presented with acute, localized anterior chest pain that has been progressively worsening over the past two weeks. He reports tenderness and swelling over the costosternal junction of the left side, exacerbated by movement and deep inspiration. The pain is described as sharp and stabbing, rated 8/10 on the visual analog scale (VAS).
History of Presenting Complaints:
The patient reports no recent trauma or injury to the chest. He denies any associated shortness of breath, cough, or palpitations. The pain is localized and not radiating to other areas. He notes that the pain intensifies with movements such as coughing, sneezing, and twisting.
Chief Complaints:
Severe, stabbing chest pain
Tenderness and swelling over the costosternal junction, left side
Past Medical and Surgical History:
No significant medical history
No previous surgeries
Family History:
No family history of similar chest pain or musculoskeletal disorders
Socioeconomic Status:
Middle class
Employed as an office manager
Medical insurance coverage
Present and Pre-morbid Functional Status:
Normally active, no limitations in daily activities prior to the onset of symptoms
General Health Status:
Otherwise healthy
No chronic medical conditions
Vitals:
Blood Pressure: 120/80 mmHg
Heart Rate: 72 bpm
Respiratory Rate: 16/min
Temperature: 98.6°F (37°C)
Oxygen Saturation: 98%
Aggravating Factors:
Movement, especially deep breathing
Coughing and sneezing
Twisting or sudden chest wall compression
Easing Factors:
Rest and avoiding chest movement
NSAIDs provide partial relief
Examination:
Localized swelling and tenderness over the left costosternal junction
No erythema or warmth
Normal lung sounds
No palpable masses or deformities
Full range of motion in the upper extremities
No neurological deficits
Sleep and 24-hour Pattern:
Disrupted sleep due to pain, difficulty finding a comfortable position
Duration of Current Symptoms:
Two weeks
Mechanism of Injury/Current Symptoms:
No specific injury reported
Symptoms began spontaneously
Progression Since the Current Episode:
Symptoms have progressively worsened over the two-week period
Significant Prior History:
No significant prior musculoskeletal or cardiovascular history
Previous Treatment:
Over-the-counter NSAIDs as needed, providing partial relief
Diagnostic Test/Imaging:
Chest X-ray: To rule out other causes of chest pain
Differential Diagnosis:
Tietze Syndrome
Costochondritis
Myocardial infarction
Pleuritis
Pulmonary embolism
Postural Observation:
Guarding of the chest wall
Slight leaning to the right to minimize chest movement
Precaution and Contraindications:
Avoidance of activities that exacerbate pain
Caution with deep breathing exercises
Functional Movement Analysis (Sign):
Restricted thoracic spine mobility during lateral flexion and rotation
Quick Screening Tests/Clearing of Additional Joint Structures:
Negative for signs of referred pain from the cervical and thoracic spine
Range of Motion (ROM):
Limited by pain, especially during deep inspiration
Special Tests:
Chest X-ray to rule out other causes of chest pain
ECG to rule out cardiac involvement
Assessment:
Tietze Syndrome – localized inflammation of the costosternal junction
Problem List/Complaints:
Severe chest pain
Tenderness and swelling over the left costosternal junction
Treatment:
Pain Management:
NSAIDs for pain relief
Ice application over the affected area
Activity Modification:
Avoidance of aggravating movements
Gentle range of motion exercises
Physical Therapy:
Thoracic spine mobilization
Breathing exercises to improve chest wall mobility
Prognosis:
Favorable, with expected improvement in symptoms over the next few weeks with conservative management
Goals:
Alleviate pain and inflammation
Restore chest wall mobility
Improve overall functional status
Interventions:
Patient education on the nature of Tietze Syndrome
Pharmacological management for pain relief
Physical therapy for mobility and strengthening exercises
Patient Education:
Understand the self-limiting nature of Tietze Syndrome
Importance of medication compliance and activity modification
When to seek medical attention (worsening symptoms or new concerns)
Patient/Family Education:
Supportive role in the patient’s adherence to treatment plan
Awareness of potential side effects of medications
Encouragement of gradual return to regular activities
Discharge Plan:
Follow-up with primary care physician in two weeks
Referral to physical therapy for further management
Contact information for any emergent concerns