Alternative Medicine/Back Injury


QUESTION: My issue is pretty complicated and I have been trying to figure out where to turn.

2 1/2 years ago my back started getting really tight in between my right shoulder blade and my spine.  The tightness soon turned into pain that I had never felt before.  It almost seemed like I needed a massage when you get a really good knot in your back, so I decided to try and get a massage at least 3 times a week.  The pain kept getting worse and worse and it got to the point where the massage therapist touched my back and it hurt so much to the point where he did not want to massage me.

A few days later at work I felt and heard a snap in the area in between my shoulder blade and spine and lost all my strength in my right arm.  The pain shot from my shoulder blade area all the way to my fingertips.  The pain was so terrible that it made me sweat.

I was taken to urgent care and was examined and was told that I had multiple back injuries that a rib popped out.  An x-ray was taken of my scapula and everything was fine.  I was placed on light duty for 3 weeks and returned back to full duty.  About 1 1/2 months later the same exact thing happened to me.  There was a snapping sound that I felt in the same area in between my shoulder blade and spine on the right side of my back.  I was taken to urgent care again and was told that I sprained my back and that a rib popped out.

I decided to go to my personal doctor and he ordered x-rays of my back.  They noticed that my right side of my back was swollen and also found in the x-ray that I had fractured a rib at my T6 level about a quarter inch away from my spine.  I was referred to PT and 3 months later the rib healed and this is where it gets interesting.

I still had a great deal of pain in the area and was sent to take an MRI.  The MRI showed nothing unusal:

L2-L3 1mm bulging disc
L3-L4 1mm bulging disc
L4-L5 1mm bulging disc
L5-S1 2mm bulging disc

Minimal bone spurs on L2, L3, L4.  All of which I was told was normal.

My personal doctor diagnosed me with chronic low back pain and I was referred to an orthopedic surgeon who diagnosed me with chronic muscle skeletal pain with no known etiology.

On my last visit to a specialist and he found on my fracture on my T6 rib that was close to my spine was curved and did not heal correctly.  The doctor said that this was a problem that I would have to deal with.  Now is there anything I can do to eliminate the pain or make the pain a little less painful?

ANSWER: Hi Mark, and thanks for writing.  

Of course online I can't diagnose your specific problem but I can give some ideas.  

First, it doesn't make sense to me why when you are having thoracic level pain, that they did a MRI of the lumbar spine and diagnosed you with chronic low back pain.  Maybe there is a part of the story that isn't above that deals with the low back?

Second, is there a reason for the rib fracture?  In a working age man without significant trauma, you probably shouldn't be breaking ribs, so one should definitely discuss their bone density and labwork with their doctor to make sure there isn't another reason for the fracture, or tumor in the bone that weakened it.  

Third, for people with chronic rib pain from non union fracture there are things that can be done.  Surgery is an option, as is having a pain management specialist do a nerve block at the level of the rib that is causing the pain.  

Again, the above are general suggestions, I can't diagnose or treat you over the computer, but above are some ideas.  

---------- FOLLOW-UP ----------

QUESTION: Your first question....After my rib healed I was having pain that went from my mid-back down to my low back.  I had explained specifically to my doctor that I was having back pain from my mid-back to low back.  I was also surprised to be diagnosed with low back pain as well.

I also was sent to do a functional capacity evaluation and I am only going to list the noticable problems that I was given in the report.

Cervical Spine ROM:

Extension: Occiput 32, T1 12, Result 20, Normal AMA guide 60

Lumbar Spine ROM:

Extension: T12 6, Sacrum 5, Result 1, Normal AMA guide 25
Left Flexion: T12 26, Sacrum 11, Result 15, Normal AMA guide 25

Shoulders ROM:

Flexion: Right 164, Normal AMA guide 180
Abduction: Right 144, Normal AMA guide 160
Internal Rotation: Right 15, Normal AMA guide 90

Hips ROM:

Hip Extension: Right 15, Left 15, Normal AMA guide 30

Knees ROM:

Knee Flexion: Right 137, Left 133, Normal AMA guide 150

2nd question....When I was injured I was sent for a referral to see a chiropractor through the company doctor.  While I was getting treated the chiropractor was supposedly going to try and manipulate my rib back into place, however it was anything other than trying to manipulate my rib back into place.  The chiropractor was pushing so hard on my ribs that every time I went to see him the pain continued to get worse and worse.  I explained the chiropractor, but he explained to me that this was not the first case that he had.  At one point the chiropractor had me get a hand towel and bite down on it, because he was pushing so hard.  It hurt so bad during those treatments that I literally wanted to cry!  Personally I think that the chiropractor fractured my rib!  I was checked for bone density and tumors which all came back negative.  I was given a CT-scan as well and everything came back normal!  I have also taken every single blood test that there is and everything has came back normal.

If there is a surgery that can be done I would like to know more on this option.  I asked my orthopedic surgeon if he could do a nerve block, but said that they would not be able to do that and that I would have to stay on antestic patches and muscle relaxers.  There has to be better options for me that patches and muscle relaxers.

I really need help!  My doctors have no idea what is going on with me!

Again I can't give specific advice, but in such a situation one should seek an orthopedic surgeon that specializes in rib surgeries.  Call larger university level hospital systems, and ask for orthopedic/spine surgeons that specialize in ribs and get an evaluation.  I would guess much of the other dysfunctions throughout your musculoskeletal system are probably all compensations to the rib area pain.  I'm going to have limited email access for a few days so good luck with your recovery.  

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Thomas Sabalaske DO


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DO Phila. College of Osteopathic Manpulation 1999

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