Rib Mediated Non-Cardiac Chest Pain: A Case Report

Abstract

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.

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

“…This phenomenon would explain why the expensive and exhaustive diagnostic testing directed at the abdomen was ineffective. Consideration of the patient’s history of non-cardiac chest pain that preceded the abdominal pain may have been the key to early, definite treatment especially if the problem was rib mediated and the patient had been referred to a musculoskeletal specialist [ 19 ].…”