Thoracic spine rib pain

by Joann
(California)

For over a month I have had right thoracic spine rib pain at T7. I don't know what initiated it. It started as just being a little sore and uncomfortable one evening after work. By the next day the pain was unbearable, a constant sharp 8 to 9 out of 10 pain. I went to urgent care where I prescribed Soma and 800mg Ibuprofen. The flexeril I take on an as needed basis for a grade 1 Spondylolisthesis at L3-L5 was not helping.

The Soma did nothing to relieve the "rhomboid spasm". I was seen by my chiropractor four days later. The major spasm is at T to 7. By that Monday my pain was no better. I went back to urgent care received a Toradol injection which did nothing for the pain. I was also prescribed Prednisone 10mg 2 times a day in conjunction with the Soma. I am currently still on these medications to help control the pain. Plus heat for 10 minutes followed by ice for 10 minutes.

I was seeing my chiropractor 2-3 times week, which helped some. He took x-rays which he said were fine and that I have severe intercostal spasms. Initially he had me on heat, ultrasound, and EMS. He is only adjusting directly around T-7 with heat and EMS, no futher ultrasound therapy after the first week. The last adjustment aggravated it more. So we stopped for the last 5 days.

I am improved to the point the pain is maybe a 1 in the morning. But after a couple of hours it is back at a 6 till I stop moving my right arm completely. It starts with a nickle sized focal point around T-7 but below my scapula. Any direct pressure on this point will immediately cause severe pain. Even marking it with a sharpie pen for my chiropractor set it off. It is best described a sharp continuous pain below my scapula. As I continue to use my arm the pain will radiate down to my mid back. It becomes very aggravated with forward motion and reaching forward with my right arm, partial upward reaching like holding a phone to my ear, any twisting to the left with a forward motion. Lifting anything over 5lbs immediately aggravates it.

It is not aggravated and quiets down by keeping my arm at my side, fully extended over my head, or contracting my ribs to the right or bending sideways with a slight backward motion to the right.

I am to start physical therapy this wed on my MD's orders but I feel like we are missing something. I really feel like it is a scapula associated problem but everyone just keeps telling me it's partially controlled intercostal pain. The thing that bothers me is it is either quiet or severe. There is no in between pain. Once aggravated I have to do heat and ice and totally stop moving my arm for hours (which usually means going to bed on the Soma and pred) to quiet it down.

I would love to hear your thoughts and see if I am on the right track.

Thank you,
Joann

One big question, Joann. Does it hurt if you take in a deep breath?

Lying on your side, ask someone to follow the rib. Is it tender in line with the armpit, the front of the chest, and does the joint between the ribs and the breastbone on the right hurt? Is it tender if you press on the sternum on the right compared to the left.

No cough, not history of breast CA? Feeling well? Just in a lot of pain. Had an epidural in the last year?


Let me know, keeping to this thread.


Dr B

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Sep 14, 2014
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follow up anwers to rib pain and tingling in the arm
by: Joann

Dr. B, No it does not hurt when I breath deeply, yes the ribs is sore to the armpit, actually my sternum is more sore on the left than the right, no coughing, no breast cancer, no epidurals, feel ok otherwise.
I have been going to PT, they feel it is a compressed disc at C-6. They have been doing EMS, heat, traction on my neck. I have had 3 treatments with a little improvement on the 3rd. But now I am having tingling on and off below the scapula and away from the spine on the right ( more towards the lats). Tingling on my left at the shoulder/ neck.
I also find it slightly more difficult to bring my right arm back, tighter than the left shoulder.
Overall it's about the same, some days are good some are bad.

Hello Joann,
A compressed disc in the neck is a possibility; then you would have pain and tingling in your left arm when you turn your head to the left, and simultaneously look up.

Also the Upper Limb Tension Test would be positive; find it in the search function in the navigation bar at Chiropractic Help; it's a test you could do at home.

It would not explain the rib pain your are getting; suggest to your chiropractor that he do only an "anterior thoracic" technique. I find with this condition that the more traditional manipulation with you lying on your tum is less effective and may increase the rib pain.

With the pain now going into the ribs on the right side, I would be starting to think of x-rays and perhaps a scan; that means an orthopaedic opinion. Don't let this go on and on; serious things do occasionally occur and with pain now on the right too, I'd be concerned.

Let me know.

Dr B

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