Thoracic spine rib pain

by Joann

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,

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
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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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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