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When the Framework Fails: The Cost of Overlooking the Basics in Chest Pain

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 6. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p5.xml)

Keywords:

case report [710]
chest pain [20]
diagnosis [394]
female [607]
OMT [3752]
osteopathic manipulative treatment [3772]
ribs [9]
women [562]

Abstract:

Introduction: Somatic dysfunction of the ribs is an underdiagnosed condition that can present with significant, unspecified pain, leading to costly and extensive workups. This case demonstrates the importance of osteopathic manipulative medicine (OMM) in diagnosing and treating rib dysfunction. Case: A 56-year-old female with a complex medical history, including lupus, fibromyalgia, asthma, and obesity, presented to the emergency department with severe unprovoked right sided lower chest pain, exacerbated by inspiration and movement of the right upper extremity. Despite reassuring cardiac, gastroenterology, and neurologic evaluations, the patient continued to have episodes of severe pain, resulting in several acute care visits. The patient underwent extensive medical workups and high-risk pain medication regimens without resolution of symptoms. During her second hospitalization, an osteopathic exam of her right lower ribs demonstrated an inhalation dysfunction. She underwent a series of osteopathic manipulative treatments (OMT) involving articulatory and muscle energy techniques that provided substantial long-term improvement in her range of motion and pain. Following OMT, she was discharged with no subsequent emergency department visits or hospital readmissions. Results: Osteopathic exam followed by OMT provided a low-risk diagnosis and treatment, resulting in improvement in the patient's symptoms, showing the potential of OMM in reducing patient harm while minimizing healthcare costs. Discussion: This case demonstrates the importance of a comprehensive osteopathic exam in chest pain evaluation, particularly when the etiology remains uncertain despite reassuring workups ruling out multiple organ systems. This case highlights the value of osteopathic assessment and treatment in achieving an efficient low-risk diagnosis and definitive treatment of rib dysfunctions, showing the potential to reduce the risk of harm to the patient while being cost-effective for both the patient and healthcare system.


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