From the Guidelines
For an 88-year-old woman with muscle strain around the lower right rib cage, I recommend a conservative treatment approach, prioritizing pain management and mobility to minimize morbidity and mortality, and improve quality of life. The patient should start with acetaminophen (Tylenol) 500-650mg every 6 hours as needed for pain, not exceeding 3000mg daily due to age-related concerns, as recommended by the 2023 WSES guidelines on the management of trauma in elderly and frail patients 1. Applying a heating pad to the affected area for 15-20 minutes several times daily can improve blood flow and reduce muscle tension. Gentle stretching exercises, focusing on slow, controlled movements without pain, can help maintain mobility.
Key Considerations
- Rest is important but complete immobilization should be avoided as it may lead to muscle weakness and stiffness.
- The patient should avoid activities that exacerbate pain for 1-2 weeks.
- If pain persists beyond 2-3 weeks or worsens significantly, further evaluation is warranted to rule out rib fracture or other conditions.
Pain Management
- Acetaminophen is the first-line treatment for managing acute trauma pain in the elderly, according to the 2023 WSES guidelines 1.
- NSAIDs should be avoided due to increased risk of gastrointestinal bleeding and kidney issues in elderly patients.
- The implementation of a Multi-Modal-Analgesia approach, including acetaminophen, gabapentinoids, and lidocaine patches, can be considered for elderly patients with severe pain, as recommended by the 2023 WSES guidelines 1.
Additional Recommendations
- The patient's vital signs and clinical features should be closely monitored to define the risk of end-of-life care, as recommended by the 2023 WSES guidelines 1.
- Involving the palliative care team as soon as possible can be beneficial in managing elderly severely injured patients at the end-of-life status, as recommended by the 2023 WSES guidelines 1.
From the Research
Note Template for an 88-year-old Woman with a Muscle Strain
Patient Information
- Age: 88 years old
- Sex: Female
- Chief Complaint: Muscle strain around the lower part of her right (R) rib cage
History of Present Illness
- The patient presents with acute pain in the lower part of her right rib cage
- The pain may have occurred during strenuous activity 2, 3
- The patient's history should be taken to determine the cause of the muscle strain and to rule out other possible causes of pain
Physical Examination
- The physical examination should include an assessment of the patient's muscle strength, flexibility, and range of motion
- The examination should also include a check for any signs of injury, such as bruising or swelling
Diagnosis
- The diagnosis of a muscle strain can usually be made based on the patient's history and physical examination 2
- Imaging studies, such as magnetic resonance imaging (MRI), may be recommended if the diagnosis is unclear or if the patient has a history of previous injuries 2, 3
Treatment
- The initial treatment for a muscle strain should include rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy 2
- As the pain and swelling subside, physical therapy should be initiated to restore flexibility and strength 2
- The patient should be advised to avoid excessive fatigue and to perform adequate warm-up before intense exercise to prevent further injury 2, 3
Medication Management
- The patient may be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol to manage pain and inflammation 4
- The patient should be advised of the potential risks and benefits of these medications and should be monitored for any adverse effects
Follow-up Care
- The patient should be followed up regularly to monitor her progress and to adjust her treatment plan as needed
- The patient should be advised to return to the clinic if she experiences any increase in pain or if she has any concerns about her condition.