544 - Traumatic Costochondral Joint Pain in a Jujitsu Athlete

Case Diagnosis: Traumatic Right Third and Fourth Costochondral Joint Pain in a Jujitsu Athlete

Case Description: A 39-year-old male presented to clinic four months after sustaining an injury during jujitsu. The reported mechanism of injury was a collision with another athlete with a direct blow to the sternum. On presentation, he reported right-sided sternal pain radiating to the back, limiting jujitsu activities. Patient noted minimal improvement with rest, chiropractic treatment, and NSAIDs. Physical exam was significant for tenderness to palpation of the right third and fourth costochondral joints with associated swelling. X-ray of the right ribs showed no evidence of structural abnormality, and he underwent right third and fourth costochondral joint injections with 0.5mL of 0.25% bupivacaine and 5mg dexamethasone. The patient returned to clinic one month later, reporting his pain started to improve the day after the procedure, his symptoms had improved by 90%, and he was back to his usual jujitsu/exercise routine. Six months post-procedure, he had not returned to clinic for additional treatment.

Discussions: In patients with musculoskeletal chest pain, there are many possible diagnoses to consider with most having limited evidence-based treatment guidelines. On review of the literature, there were no studies or case reports of refractory traumatic costochondral joint pain treated with ultrasound- guided corticosteroid injections. However, there are case reports and randomized studies discussing the favorable outcomes of ultrasound-guided corticosteroid injections into the costochondral joints in patients with Tietze disease and atraumatic costochondritis. Success in treating these conditions with ultrasound-guided corticosteroid injections raises the question of its utility in patients with traumatic costochondral joint injuries as well.

Conclusions: In patients with persistent traumatic costochondral joint pain without radiographic abnormalities that does not improve with conservative treatment, ultrasound guided injection into the affected costochondral joint(s) may be considered.