{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T12:45:35Z","timestamp":1748954735612},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:00:00Z","timestamp":1516233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Purpose<\/jats:title>\n                  <jats:p>Chest pain, a frequent complaint for seeking medical care, is often attributed to musculoskeletal pathology. Costochondritis is a common disorder presenting as chest pain. Initial physical therapist examination emphasizes red flag screening. Reexamination throughout the episode of care is critical, particularly when patients are not progressing and\/or in the presence of complex pain presentations. The purpose of this case report is to describe the clinical reasoning process in the management of a patient referred to physical therapy with a medical diagnosis of costochondritis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Description<\/jats:title>\n                  <jats:p>A 59-year-old woman presented with a 5-month history of left\u2013sided chest pain that had progressed to include the cervical and shoulder regions. She reported multiple psychosocial stressors; a depression screen was positive. She reported a history of asthma and smoking and improvement in recent fatigue, coughing, dyspnea, and sweating. At the initial visit, shoulder, cervical, and thoracic active and passive range of motion and joint mobility testing reproduced her pain. Allodynia was present throughout the painful areas in the left upper quarter.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>The patient demonstrated improvement over 30 days (4 visits). On her fifth visit (day 35), she reported an exacerbation of her chest and upper extremity pain and noted increased fatigue, sweating, dyspnea, and loss of appetite. Even though her pain was again reproduced with musculoskeletal testing, the physical therapist contacted the patient's physician regarding the change in presentation. A subsequent chest computed tomography scan revealed a non\u2013small cell lung adenocarcinoma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Cancer can masquerade as a musculoskeletal condition. This case highlights the importance of screening, clinical reasoning, and communication throughout the episode of care, particularly in the presence of chronic pain and psychosocial stressors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzy011","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T04:11:51Z","timestamp":1516248711000},"page":"503-509","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2013Small Cell Lung Carcinoma: Clinical Reasoning in the Management of a Patient Referred to Physical Therapy for Costochondritis"],"prefix":"10.1093","volume":"98","author":[{"given":"Craig P","family":"Hensley","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Ste 1100, Chicago, IL 60611 (USA)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia J","family":"Emerson","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, High Point University, High Point, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,1,18]]},"reference":[{"key":"2023011806112207100_bib1","author":"National Hospital Ambulatory Medical Care Survey: 2012 Emergency Dept Summary Tables- Table 11, 2012"},{"issue":"5","key":"2023011806112207100_bib2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.3325\/cmj.2015.56.422","article-title":"Causes of chest pain in primary care\u2014a systematic review and meta-analysis","volume":"56","author":"Haasenritter","year":"2015","journal-title":"Croat Med J"},{"key":"2023011806112207100_bib3","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.math.2012.03.013","article-title":"Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (leg) pain","volume":"17","author":"Smart","year":"2012","journal-title":"Man Ther"},{"issue":"3","key":"2023011806112207100_bib4","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jemermed.2010.11.036","article-title":"Outcome of chest pain patients discharged from a French emergency department: A 60-day prospective study","volume":"42","author":"Montassier","year":"2012","journal-title":"J Emerg Med"},{"issue":"9","key":"2023011806112207100_bib5","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1007\/s11136-013-0362-4","article-title":"Measurement properties of the QuickDASH (disabilities of the arm, shoulder and hand) outcome measure and cross-cultural adaptations of the QuickDASH: A systematic review","volume":"22","author":"Kennedy","year":"2013","journal-title":"Qual Life Res"},{"issue":"7","key":"2023011806112207100_bib6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1046\/j.1525-1497.1997.00076.x","article-title":"Case-finding instruments for depression. 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