A 52 year old sonographer was admitted to hospital with acute right sided rib and back pain. She had numerous investigations including MRI and gastroscopy which were all negative. She was discharged after a week on medication with very change in her symptoms.
This lady reported difficulty sleeping and significant pain on rising in the morning, and pain on most of her work duties, ie reaching across patients performing ulltrasound on cardiac patients. She also could not attend her usual Pilates because of pain. She was otherwise an active and healthy individual.
On assessment her main findings were hypomobility and tenderness on right T7 with assoociated muscle guarding in the oblique abdominals. Mobilisation and soft tissue release of these structures, as well as myofascial taping allowed her to sleep at night and decrease pain medication. Further treatment resulted in a resolution of all her symptoms within the next 2 weeks. She has resumed her pilates and is now pain free at work.
This case demonstrates how some acute presentations can be musculoskeletal in origin.