Sternum pain

by Andrew
(New york, New York,USA)

About a year ago I sneezed really hard and my chest was sore for 4 days; recently I aggravated it maybe in the gym. Now when I'm laying down, and go to get up, I get a pain in center of my chest; it does not hurt when touched it only hurts when crunch my upper body to get up or when I cross my arms or cough; sometimes I get a tingling feeling in my left forearm and into my fingers as well.

Hello Andrew,
A sneeze is quite violent and obviously you injured one of the many rib joints, either at the back, or with the sternum; or even one of the muscles associated with breathing.

At this stage, since the sternum is not tender or swollen, I'd classify it as a sprain of the costosternal joint; there are ligaments holding the joint in place and they have been stretched.

Ice it, do some massage between the ribs with your fingers and stop all chest and shoulder work at the gym. Probably for at least a month, and then start in slowly again.

If you start to get pain between the shoulders in the midback, then it's time to see a local chiropractor; ask him not to a hard posterior to anterior thrust on the midback as this will aggravate the sternal pain. An "anterior thoracic" technique is better.

That tingling in the arm is part of the deal. Try and identify exactly which fingers tingle, and whether turning your head and looking up provokes it.

What you want to try and prevent is this turning into a Tietze's syndrome; that hurts and is very frustrating.

Good luck.

Dr. Barrie Lewis

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Ten Rib Subluxations! Help!

by Danielle R
(Las Vegas, NV, USA)

May 31, 2018
To Whom it May Concern:
Without your amazing work and website, I would be lost. I have ten ribs in subluxations, and two lateral breaks on rib five on both sides of my body. I broke my ribs from a fall onto my thoracic spine January of 2017, in which I was given rib series x-ray two months afterwards.
Unfortunately, my ribs are not healed and continue to grind against my scapula, and protrusion of the ‘heart attack rib’ is also evident. My right pinky and ring finger go numb routinely now and the other day, my entire right leg felt as if I was paralyzed, requiring help just to stand. After about twenty times, I stop counting how many times my ribs have shifted in and out of place. This is incredibly painful and it’s starting to ruin my entire life. I was in a tragic accident that will keep me in pain the rest of my lifetime yet these broken ribs hurt worse than all 20 skin grafts and surgeries combined.
My PCP in Las Vegas, NV cannot figure out where to send me here in Nevada, except push pills down my throat by a pain specialist. I have seen a chiropractor whom refused to manipulate my ribs because he thought he may puncture my lung in office. My visit to an orthopedic specialist was also turned down as they only work on the spine. At this time, all my empirical research has lead me to believe I have TOS and am developing symptoms of Tietze's syndrome. Not even the local trauma unit referral services can point me in the right direction.
I am utterly shocked that I cannot find a doctor in NV whom can help. Good doctors, any advice? Please, I would be very grateful.
Sincerely in need of help.

Dear Danielle,
Alas you live in a society so prone to litigation that no one will take on a tough case like yours; you must just suffer, right!

It's very difficult for me to give guidance, except in very general terms. Clearly there are signs of spinal cord damage too. Has anyone every mentioned INCREASED reflexes in that right leg?

It's now 18 months since the accident and you must start to exercise. Do whatever you can; perhaps some gentle swimming; try different strokes and see what works for you. Let pain be your guide; no pain, but there obviously be discomfort.

Then I would start doing some very gentle lower back exercises before getting out of bed every morning; just pull the knees to the chest and do a few pelvic tilts.

As far as able, go for short walks, even if it's only around your home. Unless you are moving, a sedentary life will start to affect your other organs, weight, blood pressure and so on.

Become a health nut; just start to avoid the stuff that you know is crap and focus on fruit and veg, and unrefined starches; eat the food your grandmother would have put on the table. With you being so inactive, your weight will increase, and your blood sugar; you don't want to become insulin resistant on top of all your other woes. No colas whatsoever, and all the surgary things. Perhaps bake your own bread if you can find 100% wholemeal flour. At my other site, you'll find plenty of help with dietary issues.

There IS danger of any sort of manipulation of your ribs; I wonder if an activator wouldn't help? It's a more gentle form of manipulation.

A daily massage of your chest would be a great help, focusing on the muscles between the ribs, and the joints at each end, at the sternum and the spine.

Start looking for a chiropractor who is gentle and has the time to work with you; as you say, this is with you for life, and you need to find someone you can trust, and whom you can assure you won't sue the pants off him or her!

Behind a terrible accident like this, there are hidden benefits and blessings; find them. Like are you a writer? Or... who knows what?

I wish you well, and hope these general thoughts will help. I'm a Christian, and believe that out of tragedy of this nature, there is blessing to be found. Perhaps start reading your Bible, if you've never done that.

Keep in touch.

Dr Barrie Lewis DC

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Hard lump on right collarbone

Bump on collarbone

Bump on collarbone

I have had a bump on my right collarbone for about 2 weeks. No trauma or injury but I am a workout fanatic. There was no pain whatsoever or any symptoms until I did squats 2 days ago and could not really bear weight on my right shoulder.

It felt like nerve pain with some numbness and tingling all down my arm/hand. I have been resting but my shoulder aches now. I have been icing and some heat and taking Aleve for discomfort in my shoulder.

I have a separate pain on the middle of my spine when I bend backwards; about 6 days now. Feels like spine may snap if I bend too much. I do not think this has to do with my collarbone issue. I do have a better video of my bump but could not upload it.

There is no certainty about this. Perhaps you strained the SC joint but that seems unlikely. Another possibility is a condition called Tietze's syndrome which targets the joints around the sternum, but it is more usually a soft lump. That would account for the tingling in your arm, however; it frequently affects the brachial plexus. You can see more at the link below.

Did mean the left collarbone?

If it is Tietze's syndrome, which often affects the joints between the ribs and the breastbone too, then the mid-back pain may well be connected.

Follow the usual route. Rest up for a week or two, ice the joints, start slowly and lightly back into your routine, and if it does not settle within say another two weeks then you would be wise to get a professional opinion.

Dr Barrie Lewis DC

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Tietze syndrome?


I am a 32 year old female runner. I have been dealing with chest pain on and off for about 3 years now. My doctor diagnosed me Costochondritis. I recently went to a medical massage therapist for some relief. She proceeded to press on my front chest to adjust my breathing. It was quite painful. When I left her office, I noticed swelling of my 2nd rib on the right side. It was tender but not super painful. It’s been two weeks and the swelling of my rib remains. I had a chest x-ray to rule out anything serious. Is this Tietze?

Yes, it could quite possibly be. I think it unlikely that the treatment actually caused the lump; it was probably already there, but when you realised how tender the area was, then you first noticed it.

As I read it, Tietze's is just a further development of costochondritis, so your doctor was probably correct in his diagnosis.

It's a stubborn condition as you've discovered. Medicine reckons there is no cure, and they are probably right; rather, it needs to be managed. Like many medical and chiropractic conditions.

The one treatment that will definitely increase your pain is a heavy manipulation in the middle of the back; make sure your therapist and perhaps chiropractor in the future understand that.

I have worked out a protocol that certainly helps, will decrease your pain by probably 50% plus, but certainly won't cure it. I'm happy to share that with anyone treating you.

It is an inflammatory condition, hence the pain and swelling, but it doesn't respond to inflammatories. I have no evidence to prove this, but I suspect an anti-inflammatory diet is something you should consider. Frankly it is a good thing to do anyway.

Have a breast examination.

I hope this contributes. It may also give you indigestion.

Dr. Barrie Lewis

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Swelling but very little pain at the costosternal joint

by Victoria

Rib cage anatomy

Rib cage anatomy

About 9 months ago I noticed twinges I was getting in my chest around the right rib area (maybe the third rib) on my right side. The pain would come and go and would be very mild for 5-20 seconds about twice a week.

Then I started to notice the pain more often, to the point where it got to be every day and I noticed swelling in my rib area on my right side, by where the rib meets the joint. I wasn't sure what was causing it but thought it may be from picking up and holding on my hip my 20lb toddler on my left hip was somehow causing pain in my right chest/rib.

I stopped picking him up and about 6-8 weeks later the pain got less and less frequent but the swelling stayed. It got to the point where I was having no pain at all. Just the swelling was there. If I pushed on the joint area it was tender.

Last weekend I picked up my toddler a few times and noticed the area hurt again the next day. The pain was and always has been very mild. I would say 1 or 2 on a pain scale.

I have felt the pain on and off this week, the swelling is there and extends to my rib area too, past the joint and up toward my armpit, about two inches in length. I assume it is swelling but I don't know.

I feel the swelling more if my arm is raised.

I haven't taken anything for this and wasn't sure if I should just wait it out.

Thank you!

Good morning Victoria, and thank you for your letter.

It certainly sounds like you have a mild dose of Tietze's syndrome; simply because you've had this for several months, I would recommend you have the whole area examined.

Because it's in the area around your breast and extending towards the armpit, I'd recommend you start with a consultation with your medical doctor, just to be sure there's nothing else going on.

Research shows anti inflammatory tablets won't help the chest pain, so don't accept any.

Then any ongoing joint pain needs to be evaluated by your chiropractor; the difficulty is that this is a nuggety chronic condition that can be very severe, and many of my colleagues have probably never heard of it. I hadn't until I'd been in practice for some 25 years.

And, please note this, a heavy chiropractic manipulation in the middle of the back will worsen it. So you need to find the right person, and talk very forthrightly about it; until I understood the condition, I aggravated numerous cases, and you don't want to be a victim! It's called iatrogenic disease, the third most common condition; doctor-caused illness.

Don't by put off by these comments, but it does mean you have to find a chiropractor knowledgeable about Tietze's syndrome and will treat you more gently; the 'anterior thoracic' adjustment is the treatment of choice. Ask before making an appointment. If you read the other letters on the subject you'll soon realise it can become very severe; rather nip it in the bud.

Alternating ice and heat, as in the shower, and gentle massage of the area helps too. If carrying your child on the hip seems to be an aggravating factor, then certainly avoid it where possible.

Good luck, and I hope this contributes. Fire away if you have any more questions.

Read 'find a good DC' in the navigation bar at chiropractic help.

Dr. Barrie Lewis

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Breast pain during reconstruction then car accident

by Cheryl
(Valparaiso, IN)

Rib cage anatomy

Rib cage anatomy

I had a double mastectomy and the doctor was starting reconstruction doing the flap surgeries using my back muscles and the expander; then I got into a bad car accident and got necrosis, it is healing after 3 months, by now I have horrible pain in my breast, arm, ribs, shoulder etc; know one knows. Now only on the right side, left is fine.

Hello Cheryl,
To make a diagnosis of Tietze's syndrome you must have very specific costo-sternal, or clavicular sternal joint pain, with a palpable lump.

It's not impossible, but probably more likely is multiple joint injuries from the MVA and necrosis.

If you have that lump, let me know and we take this further; a photograph sent to contact would help, though it's difficult to get a clear picture; getting the light right to cast a shadow is necessary.

Dr. Barrie Lewis

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