Chest And Neck Pain In A Tennis Player

Abstract

HISTORY: An 18-year old male D-1 tennis player presented to the office with new onset pain in his chest and neck. It started the night prior to presentation in the center of his chest. He fell asleep without pain, but the next day noted pain in his upper chest and neck. He described it as a stiffness and as a weight pressing down on his chest. The pain was constant and worse with swallowing, speaking, neck extension, and head rotation. He also reported feeling more out of breath than usual. Two days prior to symptom presentation, he performed baseline strength testing. He denied fevers, pain with neck flexion, radiation to either arm, syncope, wheezing, sore throat, N/V/D or headache. He had no personal or family history of asthma, pneumothorax, or cardiac disease. He denied current or prior smoking, drug use, and vaping. PHYSICAL EXAM: Vitals: Ht 182 cm, Wt 77.1 kg, BP 119/74, HR 74 bpm, Temp 36.6 C (oral), BMI 23.2 Gen: NAD, nontoxic ENT: no pharyngeal erythema or tonsillar swelling Neck: no lymphadenopathy. Supple, full ROM but pain in full extension. No TTP of spine or soft tissues. CV: RRR, no M/R/G Resp: CTA bilaterally, good air entry, no wheeze, no accessory muscle use Chest: No TTP of ribs, sternum, costo-sternal joint, or intercostal spaces. No palpable subcutaneous crepitus to the chest or neck. Skin: no erythema of the skin of neck or chest DIFFERENTIAL DIAGNOSIS: Acute coronary syndrome Pneumomediastinum Strain Infection Asthma TESTING: X-ray of Chest/Neck: Lucency seen along paravertebral regions of upper thorax raising concern for pneumomediastinum. No pneumothorax. FINAL DIAGNOSIS: Spontaneous pneumomediastinum TREATMENT/OUTCOME: Patient was held from activity until follow-up weekly X-rays demonstrated resolution of free air in the neck. Symptoms and X-ray findings resolved within two weeks. He was cleared at 2 weeks with a gradual progression of activity and avoidance of full exertion or weight lifting. One week later, he was cleared to return to full activity with no restrictions. He was advised to avoid breath-holding with activity. He has had no recurrence of symptoms.