Rib Mediated Non-Cardiac Chest Pain: A Case Report.

Non-cardiac chest pain (NCCP) is a very common and functionally limiting pain complaint that vexes patients and medical providers leading to time-consuming and expensive diagnostic work-ups as well as significant disability and lost productivity. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, or interventional management procedures for the diagnosis and alleviation of NCCP. In patients presenting with chest pain, after ruling out life-threatening causes, the diagnosis of NCCP is made. This process is a diagnosis of exclusion rather than a specific etiology with a defined treatment plan. This results in specialty consultation, advanced diagnostic testing, and delayed definitive care. A better triage process may include the incorporation of diagnostic maneuvers at the primary care and emergency room to justify referral to a musculoskeletal specialist in lieu of or during advanced diagnostic work-up. After the diagnosis of NCCP is made in our young and active patient population, we have seen significant success in the application of manipulation and a functional restoration program similar to the presented case. To our knowledge, this treatment approach has not been previously described. While this management strategy may be taught in physiotherapy courses, we provide the case to illustrate a multimodal treatment approach that seems to be unknown or underutilized based on the number of referrals and prevalence of this condition.

Evaluation and Management of Sacroiliac Dysfunction Utilizing an Evidence-Based Algorithmic Approach: A Case Study.

The sacroiliac joint (SIJ) is an important contributor to persistent and functionally limiting lower back pain. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, nor interventional or surgical management procedures for the alleviation of pain originating from the SIJ. Traditional physical therapy and conservative approaches to generalized lower back pain often fail in this patient subset prompting sub-specialty consultation to a pain management center. Diagnosis of the SIJ as the pain generator can be accomplished through physical exam maneuvers and comparative diagnostic blocks; however, upon diagnosis, management remains a challenge. After the diagnosis of SIJ dysfunction is made in our young and active patient population, we have seen significant success in the application of an interdisciplinary and evidence-based treatment algorithm similar to the presented case. To our knowledge, this treatment approach has not been previously described.

A Novel Approach to Assessing and Treating Musculoskeletal-Mediated Atypical Abdominal Pain: A Case Study.

Abdominal pain is a common and functionally limiting complaint within the healthcare system linked to impaired quality of life and increased health care utilization. This chief complaint is associated with an extensive differential diagnosis leading to high utilization of diagnostic testing, increased healthcare cost, and delayed access to care. In patients presenting with acute or chronic abdominal pain, musculoskeletal pain often requires expensive testing, thereby delaying definitive care. An improved triage process is warranted. Performing a musculoskeletal examination to determine if pain patterns can be mechanically reproduced at the site of origin, or remote to the site of pain, warrants referral to a musculoskeletal specialist. In our young and healthy population, once the musculoskeletal mediated abdominal pain origin is determined, we see significant success in the application of a treatment approach consisting of manipulative therapy, exercise, and instrument-assisted soft tissue mobilization. A multimodal treatment approach for musculoskeletal-mediated abdominal pain has not been previously described. This case study outlines a novel management approach for musculoskeletal-mediated abdominal pain and provides an alternative diagnostic technique, when implemented early in the evaluation and management process of atypical abdominal pain, that improves the quality of life.