Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What helps costochondritis go away?
Why does costochondritis flare up?
What irritates costochondritis?
How do you diagnose costochondritis?
Does costochondritis hurt to touch?
What are the trigger points for costochondritis?
What mimics costochondritis pain?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
So it seems like you're experiencing right-sided chest pain and numbness in your right hand, is that correct?
Patient
Yes, that's right.
Cody, the AI Doctor
Good to meet you! My goal is to provide you with an accurate assessment and plan. Can you tell me when you first noticed these symptoms?
Patient
The chest pain started about a week ago, and the numbness began around three days later.
Cody, the AI Doctor
Thank you for that information. Have you engaged in any recent physical activities or experienced any injuries that might explain these symptoms?
Patient
I did help a friend move some heavy furniture about a week and a half ago.
Cody, the AI Doctor
Activities like moving heavy furniture can sometimes lead to muscle strains or sprains. How would you describe the nature of your chest pain? Is it sharp, dull, or of a burning quality?
Patient
The pain is sharp and it gets worse when I take deep breaths or move my upper body.
Cody, the AI Doctor
A sharp pain that worsens with movement or deep breathing often suggests a musculoskeletal cause. Do you have any additional symptoms like shortness of breath, cough, or fever?
Patient
No, I haven't noticed any of those symptoms.
Cody, the AI Doctor
That's helpful to know. Regarding the numbness in your right hand, is it constant or does it come and go? Are there specific activities or positions that seem to make it worse?
Patient
The numbness comes and goes, and it often gets worse when I use my right hand a lot or keep it in the same position for a long time.
Cody, the AI Doctor
I understand. Do you have any history of medical conditions such as diabetes, a history of rib fractures, or any known nerve-related issues?
Patient
No, I don't have any history of medical conditions.
Cody, the AI Doctor
Noted. On a scale of 1 to 10, with 1 being no pain and 10 being the worst pain imaginable, how would you rate your current chest pain?
Patient
I would rate it around a 6.
Cody, the AI Doctor
Understood. Does anything relieve or worsen the pain, such as rest or applying pressure?
Patient
Rest helps a bit, and applying pressure makes the pain worse.
Cody, the AI Doctor
Given that information, it’s highly possible that your symptoms could be due to costochondritis, an inflammation of the cartilage that connects your ribs to your breastbone. However, I want to ensure we rule out other potential causes like muscle strain or nerve issues. Does the numbness in your hand cause any weakness or affect your ability to grip objects?
Patient
It doesn’t cause weakness, but it does make my grip feel odd sometimes.
Cody, the AI Doctor
Do you have any additional symptoms like tingling sensations in other parts of your body, or any unusual sensations in your chest, like palpitations?
Patient
No, the numbness is only in my right hand, and I haven’t had any palpitations.
Cody, the AI Doctor
Encouragingly, the lack of systemic symptoms like fever and shortness of breath makes serious conditions like infections or pulmonary issues less likely.
Cody's AI Summary
- You are a 22-year-old man with chest pain and hand numbness for about a week, which is described as sharp and exacerbated by deep breaths or upper body movements.
- The right-sided chest pain was preceded by helping a friend move heavy furniture, which may have contributed to your symptoms.
- After three days, you began to experience numbness in your right hand that comes and goes, especially when using the hand extensively or keeping it in the same position.
- You have not noticed any additional symptoms such as shortness of breath, cough, or fever.
- You have no history of underlying medical conditions
- There is no weakness associated with the numbness but it occasionally affects your grip.
- You do not report any unusual chest sensations such as palpitations.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Costochondritis(40 % probability)
Inflammation of the cartilage that connects a rib to the breastbone.
2. Muscle Strain(35 % probability)
Overstretching or tearing of muscle fibers, often causing localized pain and tenderness.
3. Peripheral Neuropathy(25 % probability)
Damage to the peripheral nerves causing numbness, tingling, and pain in the hands and feet.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
Based on the history provided, the primary probable diagnosis, as suggested by Cody, is costochondritis. This condition is characterized by inflammation of the cartilage connecting the ribs to the sternum and is often linked to physical exertion, explaining the sharp pain worsened by movement and deep breathing. This condition is often dismissed as trivial, but it can cause real symptoms and concerns. I rate costochondritis highest on the list. Muscle strain is second, given the recent activity of moving heavy furniture and the absence of systemic symptoms. Either way, costochondritis and muscle strain will be treated similarly.
1. Costochondritis(70% probability)
This is highly probable given the description of pain, recent exertion, and localized tenderness. Inflammation of the intercostal cartilage can cause significant pain that is often sharp and exacerbated with physical activity and deep breathing.
2. Muscle strain(25% probability)
Considering the recent strenuous activity, muscle strain is a strong contender, contributing to sharp, focal pain without systemic involvement.
3. Peripheral neuropathy(5% probability)
Although less likely given the patient lacks predisposing conditions (e.g., diabetes), the episodic numbness should keep nerve compression or irritation on the radar, such as cervical radiculopathy due to pinched nerves.
Next Steps for Evaluation
To reach a definitive diagnosis, a physical exam to palpate the chest wall and assess for tenderness over the costochondral junctions can help confirm costochondritis.
Imaging, although typically not necessary for costochondritis, might be considered, if symptoms persist or worsen, to rule out other causes like rib fractures.
For the episodic numbness, a neurological examination including nerve conduction studies could be useful if symptoms persist.
Potential Treatment Modalities
For costochondritis: Initial management includes rest and avoidance of movements that exacerbate pain, along with NSAIDs (such as ibuprofen) to reduce inflammation. Physical therapy might be beneficial to improve thoracic mobility.
For muscle strain: Similar conservative measures including rest, ice application, NSAIDs, and gradual reintroduction of exercise and strengthening as tolerated.
For peripheral neuropathy: If confirmed, addressing the underlying cause, physical therapy, and medications for nerve pain could be indicated.
Resource Center
Testimonials
Just loved getting the peace of mind that I’m not the only one that have had these issues and it’s not as bad as I thought. Still going to get an opinion, but am at ease because of this platform. Will be using again and again.
TrustPilot Review
Genuinely saved my life. I went to an Instacare for severe abdominal pain and was told to take Tums for the next two weeks. I left feeling rushed out and unheard. I wrote out my symptoms to CodyMD and was told there’s a 75% chance I have acute appendicitis. I took myself to the hospital and had emergency surgery the same morning.
TrustPilot Review
CodyMD is a very precise and accessible app. My consultation with CodymMD is commendable and I highly recommend it for others to try CodyMD especially for assessment and consultation purposes.
TrustPilot Review
