Rib pain causes

Hereditary

Rib pain causes may be inherited as from a scoliosis or from trauma.



These normally long and slender bones pertain to the mid back, or thoracic spine. But occasionally folk may inherit a gene that gives them one on the seventh cervical vertebra; then it's usually short and stubby, but may have a lengthy piece of cartilage attached, unseen on xray.

Mostly these are rudimentary, small and of little consequence, but very occasionally these cervical anomalies can be large and interfere with two vital structures that pass to and from the arm; the artery and nerves that supply the upper limb.

Below you can see the marvelous graphic artist's impression of these unusual enlarged transverse processes of the seventh cervical vertebra. On the left is the inter scalene triangle through which the axillary artery passes on its way to the arm.

Through this triangle, between the scalene muscles, the very large brachial plexus of nerves also pass. If there's an anomalous cervical bone taking up space it can severely affect the arm.

Sharp stabs in the mid back at the chiropractic coalface is an every day affair. Mostly, dealing with it is fairly straight forward, but these anomalous structures can make life a lot more difficult.


1. Cervical ribs


Hereditary conditions like a cervical rib, a short leg, or leg length inequality in anatomical terminology, or old trauma can't easily be undone.

But sharp mid back pain after a sneeze is straight forward provided you don't delay for weeks.

The classic sign of a cervical rib is that the arm tires very quickly, and may tingle and ache, especially when working above your head.

Chiropractic usually helps, but will certainly not in any way cure the condition. Surgical removal of the cervical rib may constitute a cure, but it's a grisly operation via the armpit, sometimes injuring the artery or nerves.

Here is an aside worth considering; when is it better to accept some disability rather than risk a potentially dangerous operation, or medication, which might improve the condition, but may also worsen the condition? It's a difficult question, requiring wisdom and a willingness to discuss fully with those experts involved to weigh what the benefit versus risks ratio is. The general anesthetic alone, especially in the very young and elderly, is not without risk. 

On a personal note, my anesthetist confided in me after a minor operation that she very nearly lost me when I was only forty years old. It was a sobering confession.

The classic test is Adson's test which assesses the pulse in your wrist as you go through complex series of movements to narrow the gap in the interscalene triangle.


Rib pain causes


Holding the telephone between your shoulder and your neck will greatly aggravate any cervical rib pain, provoking a possible pinched nerve in neck ...



2. Lumbar ribs - pain under rib cage

Less uncommon, the first lumbar vertebra may have a rudimentary rib. Usually there is an associated anomaly at the base of the lumbar spine, which is more likely to give trouble than the rib.

However, this lumbar rib may be associated with the many conditions associated with the thoraco-lumbar junction. A Maigne's syndrome that may refer to the buttock and groin via the Superior Cluneal nerves, a Meralgia paresthetica causing numbness and sometimes pain and tingling on the side of the thigh. And other slips of nerves belonging to the Femoral nerve complex passing to the inguinal and genital areas.



Short leg


3. Leg length inequality

Pain under right rib cage

Short leg is the most common cause of a scoliosis.

Whilst these anomalous ribs, or a subluxation at the thoracolumbar junction may cause pain under the cage, on the right one needs to consider whether the gall bladder, or liver aren't the spokes in the wheel. The usual right upper quadrant abdominal palpation can usually make the differential diagnosis.

For discomfort under the left cage, less commonly a spleen condition perhaps should be considered. However this is rare and the old adage is followed; if you hear hoof beats, think horses first, and only zebras later. But striped animals aren't just found in the bushveld; occasionally they may be one lurking in the chest cavity.



Abdominal palpation should be part of the normal examination in all such cases. An enlarged and tender liver or spleen obviously calls for a second opinion, and further tests.

Here's an interesting, typical case file from the chiropractic clinic. A 27 year old woman for no reason suddenly developed very severe left lower thoracic pain. It happened whilst running, which she did regularly. She did gym the evening before, perhaps injuring herself. Taking in a deep breath provoked the stabs suggesting a rib condition. The twelfth was exquisitely tender on palpation, as was lateral flexion.

There was also spreading pain under the left rib cage, but palpation of the spleen and upper quadrant were negative.

She responded very rapidly to the usual chiropractic adjustment, with 50 percent less pain after one treatment and almost none after three. The Maigne's syndrome exercises and an orthotic in the shoe to correct for a short leg were vital to prevent a regression. Rib and back complaints are not uncommon.



A short leg may have been caused by a femoral or tibial fracture, but it's also an inheritable feature. It frequently causes the scoliosis often associated with rib pain.

It's not difficult to imagine how a short leg on your reading left in the case above could be one of the spine and rib pain causes.

Here's an important thought. Ask your child to bend forwards, knees straight, and check the spine. Is there an obviously uneven back? An unskilled yet observant person can detect this rib pain cause.

Grandad, whilst you are showing that very important little person in your life some insights into one of your hobbies, you too might ask the lad or lass to bend over and have a look at the shape of their spines; an ounce of prevention and all that. Once they reach sixteen the spine is formed and it's late to make significant changes.

Obviously, in today's devious world, it may we wise first to gain the parent's permission. Done together, in any case, it would carry more weight.


Pain under rib cage

It's not difficult to understand, looking at the x-ray below, that your doctor of chiropractic will be considering beyond that crooked spine other rib pain causes. Once again, though, it's the horses and the odd stray zebra story.

One of the quite rib pain causes is cancer of the pancreas; it's known classically to refer pain to the back and must be included in the differential diagnosis if there is any suggestion of unexplained weight loss, malaise and fatigue; and if the patient is not responding to chiropractic treatment of the spine and ribs as expected.



Rib and back pain


An apex to the curve often exists around the thoraco-lumbar junction making this area vulnerable. A T12 or 12th rib subluxation often may cause rib and back pain possibly causing pain under rib cage.


Sneezing

Sneezing, especially if twisted at the time, or getting up from a chair, is a common cause of acute, sometimes very acute, mid back rib pain.

Each rib attaches to the spine via three joints. Subluxation of one of these joints causes very severe, stabbing mid back pain. See the red arrows below. The so-called "sprung rib" in chiropractic jargon. The painful sprung rib is a condition that responds, almost always, very quickly to the the Chiropractic adjustment.




Traumatic rib pain causes

Another of the rib pain causes is trauma to the rib cage. A shoulder charge in rugby, a powerful jerk by your car safety belt that may save your life, but leave you with severely contused ribs...

Another, I confess, is an overly robust mid back manipulation. I admit myself to seven cracked ribs in 33 years, all seven recovered with no sequelae but at the time there was quite severe pain with every breath.


Aside: Would you sue your chiropractor for cracking a rib? Was it negligence? Was s/he contrite? Did you get a vase of flowers?

All human beings, doctors included make mistakes periodically. If you sue your doctor every time something goes wrong, you will be a little richer, perhaps a lot richer, feel vindicated; but on the downside, there's always the risk that s/he becomes despondent and makes a career change. Is it worth putting several thousand patients out of their doctor/ chiropractor because he made a mistake like using a little too much force and cracking a rib?

The other downside is that doctors will be reluctant to get on and do what they have to do if there's the slightest risk. Patients will take longer to recover, or not recover, just because doctors have become so intimidated.

Happily none of the seven sued me!



Breastbone pain

Breastbone pain can be very debilitating.

A dysfunctional rib, for whatever reason, affects not only the three joints between the rib and the spinal vertebra, but also the joint between the rib and the breastbone.

Breastbone pain, aka Tietzes syndrome comes in four grades, the fourth being a swollen node over the joint. It can be extremely debilitating, lasting for years. If over the left side of the chest, patients often think they are having a heart attack or angina. Hence the term "heart-attack rib".

Trauma to the chest is a common cause such as a fall on the fist whilst skating, but also after mastectomy and breast enlargement surgery.




The first rib


Part of the so-called "inter scalene triangle" a first rib subluxation is a vital part of the arm pain syndromes. Affecting both the artery to the arm and the nerves, a "thoracic outlet syndrome" is a major cause of the pain and tingling in arms and hands syndromes that face your chiropractor every day.

The frozen shoulder for example, and a carpal tunnel syndrome are frequently associated with a first rib fixation. Dealing with this rib pain cause is what makes Chiropractic very successful in treating the arm pain syndromes.


The transitional areas of the spine - headache from the atlanto occipital joint, the lower cervical spine, the thoraco-lumbar juction and the lumbo-sacral areas are the most difficult in the management of the spine.

The first rib - T1 rib - is not unusual in this regard, at the cervico-thoracic junction.


Medical illness @ rib pain causes

Whilst it's a lot less common at the Chiropractic Coalface, every chiropractor knows that a case of walking pneumonia, a lung tumour, pancreatic cancer, breast cancer can cause mid back pain, simulating a rib condition.

Metastases from breast cancer to the ribs; it's important that you report other medical conditions to your chiropractor. Are you taking post menopausal hormones? Research shows that you can expect dramas in your future health.

Just recently I had a patient who had non Hodgkins lymphoma of the thymus gland; treatment was only possibly if the surgeon could put his hand into an aperture made between the ribs. This caused tremendous stress of the joints at each end of the ribs involved.

She is happy to be alive, and chiropractic help enables her to cope with the rib pain; it's not perfect, but she's happy.


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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