Case

A patient presents with pain on the right side of their abdomen that has been present for the last couple of days.  They were splitting wood with an axe on the weekend. The pain is greatest in the afternoon/evening and not much pain is experienced when sitting or laying still.  The pain worsens when coughing, sneezing, defecating, or twisting the torso to the right.

Question 2/2 - What is your initial plan for this patient?

Click on your selected option(s) below  (correct = 2,  over-thinking = 3+)

Case Complete

Correct! Most muscle strains resolve within reduction in pain over several days through to complete resolution over several weeks.  The patient would be instructed to return if the pain does not start to diminish. 

Incorrect. Soft tissue injury does not show particularly well on CT imaging and this would be unlikely to provide additional actionable information.    

Incorrect. While MRI shows excellent soft tissue detail, most muscle strains are at a micro-cellular level below ready detection with imaging. The cost and time of an MRI would not be needed for this case.

Incorrect. Major muscle injury has surgical options (more to come on when we use that in the MS2 Skin, Bones, and Musculature course). It is rarely the first step unless muscles are completely ruptured and specific muscles (not usually abdominal obliques), which the case does not suggest as the patient has good movement and only discomfort with pain during movement.

Correct! A non-steroidal anti-inflammatory drug (NSAID) based pain medication is the typical initial action for suspected muscle strain.