I would agree with Owen. He needs to have x-rays taken. Otherwise your plan
sounds appropriate and should resolve his sxs.
Owen Sant' Angelo wrote:
> Is Ca ruled out ?
> -----Original Message-----
> From: Tobias Sundberg <[log in to unmask]>
> To: Tobias Altavista <[log in to unmask]>
> Date: Friday, September 17, 1999 7:15 PM
> Subject: Tietzes and/or costochondritis?
>
> >Dear list members,
> >
> >I would appreciate any help and ideas regarding PT management of the
> following case:
> >
> >Patient: Male, 28 years old, works as a personal trainer and is also a very
> active athlete (martial arts & weightlifting).
> >
> >History: Diffuse symtoms in thoracic spine and chest for some 4 months.
> Debut initially after an highly intensive bout of bench
> pressing/weightlifting (hard training for 8-10 weeks before competition)
> earlier this spring. Has since then NOT stopped his weightlifting or
> training routine although low grade pain, but has changed to a routine
> excluding benchpresses and got temporarily better (not completely pain free
> though). Got worse after trying another series of benchpress workouts last
> month and is now seeking help from MD and PT. MD has given diclofenac
> (Voltaren) for pain and as antiinflammatory agent and is now waiting 14 days
> to see if medication has effect. Blood status not yet given. No reumatoid
> factors discovered so far. No current X-ray or other lab test so far.
> Tietzes syndrome and/or costochondritis is suspected.
> >
> >Current status and symptoms: Typically inflammatory symptoms with
> aggrevated pain in the mornings and after periods (>20-30min) of sitting
> still. Pain is localised bilaterally around upper chest, sternum and
> anterior rib joints (primarely costae I-III but also IV-V), somewhat more on
> left side. Also "burning" sensation in middle back (approx T3/4-T8)
> specially occurs with long standing or sitting at desk writing. Full
> AROM/PROM all periferal joints and spine except for painful facett joints
> and spinous processes during provokative testing/palpation of middle
> T-spine. Generalized triggerpoints/myofascial pain in muscles around
> shoulder girdle/trapz/rhombs/pecs. Pat also has a vague sense of wanting to
> caugh ("tickling" in chest area) after sitting still, which the MD told
> could be normally assiciated with the Tietzes syndrome...
> >
> >Rx Plan: Let pat continue training and aerobic exercises (he has VERY
> difficult not to, due to job and personal status) but exclude ALL pressing
> exercises for next month. NO combat wrestling for 3-4 wks to see if
> medication has effect. Gentle mobilization of thoracic spine and stretching
> of muscles to address triggerpoints and affected soft tissues. Give pat
> specific stretching routines to do at home for chest and shoulder muscles.
> >
> >
> >QUESTION: Apart from the PT management suggested above and medication, do
> you know of any other treatment that has been shown useful to directly
> address costochondritis/Tietzes syndrome. I have searched medical books and
> internet with little results. Any ideas on: Steroid injections,
> electrotherapy, other modalities, orthoses etc? Patient is VERY concerned as
> he feels his body is "his business" so to speak...
> >
> >Thank you,
> >
> >Tobias
> >
> >--------------------------------------------
> >Tobias Sundberg, PT
> >[log in to unmask]
> >--------------------------------------------
> >
> >(Please note that this message has been cross-posted to several lists.)
> >
> >
> >
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