A 43-year-old woman was seen in the emergency department complaining of a severe localized pain over the left side of the chest. She stated that the pain started quite suddenly, about 1 hour previously, when she was reaching for a book on a high shelf. On further questioning she disclosed that she had been sailing with her husband the previous day and that they had been caught in a storm. She described the pain as a continuous dull ache that was made worse by taking deep breaths and using the left arm. She indicated that the pain was localized over the sixth left costal cartilage about 2 in. to the left of the sternum, which corresponded to an area of tenderness over the sixth left costochondral junction.
-The following possible conditions could explain the severe chest pain. Choose the most likely diagnosis based on your knowledge of anatomy.

Question

Quizplus · Accepted Answer

Separation of the sixth left costochondral joint or an acute costochondritis can be extremely painful conditions. The injury must have occurred when the patient was pulling on the ropes of the sailing boat during the storm on the previous day. The joint is innervated by the sixth intercostal nerve and the pain is localized over the affected joint. This case is a good example of somatic pain that may be intense and localized, in contradistinction to visceral pain, which is diffuse and poorly localized.

A 43-Year-Old Woman Was Seen in the Emergency Department Complaining