Thoracic Injury - Swimming

Abstract

1597 HISTORY – A 20-year-old female division III collegiate swimmer was jumping up and down, warming up prior to a race, when she experienced pain in her left lower rib cage. She reported the pain to a certified athletic trainer after the race and completed two more events that day. There had been no obvious trauma to the area and no prior history of thoracic injury. PHYSICAL EXAMINATION – Subsequent evaluation by the athletic training staff three days post injury revealed no swelling, deformity, or discoloration. The athlete was having trouble sleeping, was most comfortable slouched over (thoracic area not on stretch), and reported moderate to severe pain over the left lower rib cage, with pain at this same level in the back. Positive compression, valsalva, and sit-up tests were noted. The athlete was scheduled to see the team physician the following day. The team physician's evaluation revealed no further remarkable findings. The athlete sought chiropractic care four months post injury because of unresolved symptoms, a non-surgical sports medicine physician, with subsequent referral to a thoracic surgeon six months post injury. DIFFERENTIAL DIAGNOSIS: Intercostal strain Oblique strain Fractured rib Somatic dysfunction Left lower rib cage pain Slipping rib syndrome TESTS AND RESULTS: Radiographs from: Team physician (4 days post injury) … Negative Chiropractor (4 months post injury) … Negative Non-surgical sports medicine physician (6 months post injury) … Negative Bone scan: Negative Nerve Block: To perform “hooking maneuver” … Positive FINAL/WORKING DIAGNOSIS: Slipping Rib Syndrome TREATMENT AND OUTCOMES: Conservative treatment (e.g., ice, activity modification, ultra sound, heat packs, antiinflammatories) three to four months post injury. Chiropractic interventions (total of 12 treatments) four to six months post injury.Focus of the treatments was on spinal manipulations and electrical stimulation.Physical therapy (total of 10 visits) six to eight months post injury. Focus was on manual therapy (various mobilization techniques) and therapeutic exercises (e.g., stretching, strengthening). Surgical intervention nine months post injury. Resection of an abnormal cartilaginous attachment of rib 11 to 10 and a resection of a portion of the 12th rib. Athlete rested (no activity) for 6 weeks post surgery. Athlete began swimming three weeks post surgery, has been swimming for two weeks now, and is currently up to 3,000 yards a day and progressing with minimal discomfort.