Case Study; Sophie
Sophie was new to rowing. She had the high level of conditioning and strength training required to be successful in the sport, but was just beginning to learn the intricacies of it. She and her team members spent a lot of time in the boats learning how to properly do the skull or sweep rows and how to generate “power” throughout each stroke.
After training for about two months, Sophie began experiencing sharp pains (8/10) on the right side of her rib cage. She tried to push through the pain but it hurt for her to breathe, twist, and pull on the oars. When she felt the area that hurt, she noticed a lump that was “squishy” and very tender to the touch.
When Sophie went to the athletic training clinic, her clinician initiated the evaluation by taking a complete medical history. The clinician learned that Sophie had felt a pop a few days prior with significant pain afterwards in her ribs. Her breathing patterns were shallow due to pain, and it hurt to laugh. The evaluation showed a positive rib compression test (anterior/posterior compression) at the sixth rib level, pain (9/10) with palpation over the sixth rib and tenderness (7/10) with palpation over the adjacent ribs. There was some discoloration and oedema present over the area of complaint. Palpation over the adjoining thoracic vertebra was unremarkable and her trunk mobility was limited due to pain.
So...
- Based on this scenario, what differential diagnosis would you consider for Sophie?
- What are several anatomical soft tissues in the area of pain that could be contributing to Sophie's problem?
Use the Trail Guide to the Body (pages below) to help formulate your ideas on this question.
- Topographical Views 168
- Exploring the Skin and Fascia 169
- Bones of the Spine and Thorax 170
- Bony Landmarks of the Spine and Thorax 171
- Overview: Bony Landmark Trails 174
- Overview: Muscles of the Spine and Thorax 188
- Synergists—Muscles Working Together 194
- Muscles of the Spine and Thorax 196
- Ligaments and Other Structures of the Spine and Thorax 218
- What was the mechanism of injury for Sophie?
- By using your palpation skills, what specific structures should be palpated on a patient with this complaint?
- Identify the landmarks that could be used to easily locate the sixth rib.
Adapted from Robert Stow, PhD, ATC, LAT University of Wisconsin – Eau Clai