Disclosures: Nicholas Tsitsilianos, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 27-year-old male boxer presents with a chief concern of left-sided chest pain.

Case Description: A professional boxer sustained a punch to his left anterolateral chest wall during a match resulting in immediate pain. He completed the round but was unable to finish the match due to pain. He denied focal bruising but noted increased fullness and pain in his left upper abdomen, we well as left sided chest wall pain. The pain, described as sharp, sore, and aching, was exacerbated by turning and coughing/sneezing. Alleviating factors included ice and stretching. He presented for evaluation three weeks post-injury reporting 75% improvement in pain at rest but continued symptoms with coughing/sneezing and uppercut maneuver. Physical exam revealed asymmetry of the upper left rectus abdominus muscle, no bruising or swelling, and tenderness over the anterior costochondral margin of the left 8th/9th ribs with slight dynamic instability appreciated. There was full thoracic spine range of motion and no pain with deep inspiration.

Setting: Sports Medicine Clinic.Assessment/

Results: Radiographs were negative for rib fracture. In-office ultrasound, showed evidence of a defect in the chondral surface at the area of pain suspicious for a fracture. MRI chest confirmed an anteriorly displaced fracture of the costal cartilage at the left anterior chest, likely involving the 7th or 8th rib.

Discussion: This case highlights the importance of thorough evaluation in the face of results contradicting clinical suspicion. This negative x-ray may have resulted in hastened return to sport and possible further injury. This case also highlights the utility of in-office diagnostic musculoskeletal ultrasound to identify occult cartilaginous injury often missed by other imaging modalities.

Conclusion: Diagnostic musculoskeletal ultrasound is an efficient diagnostic tool for the identification of musculoskeletal injuries, especially in the ribs, and can help ensure accurate clinical diagnosis to enable establishment of a proper plan for return to sport.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-boxer-with-chest-pain-a-case-report/