Expert: Dr. Victor Dolan, DC, DACBSP - 5/21/2008

Question
Hi Dr. Dolan: I will try to make this short but my daughter who is now 19 had heart surgery at 6 months old. She is doing fine except 4 years ago as she was growing her sternum started to rotate and pulled three ribs out of their junctions. We had a rib resection done which helped for awhile and then 3 other ribs dislocated. We then had another rib resection done. that lasted about 6 months and has had more rib dislocations, ribs popping in and out, inflammatio in her chest and severe pain. It has made it impossible for her to do certain ordinary things because her ribs pop in and out all the time and cause severe pain. We have been to a few specialists that say they have never encountered this problem and have no answers. Curently she is on Tramadol for pain and also Neurontin for nerve pain caused by the first rib resection. Have you ever heard of this before? This was caused by the way her sternum fused back together after her surgery and how she grew. We really need help with this so she doesnt have to live in pain her whole life or at the very least be able to manage it.  Thank you.

Answer
Hello Debra,

Sorry to hear of your young daughter's problems.  Yes, it would be terrible to think at this age that the entire life ahead will be painful and possibly cosmetically unappealing.

As a child or adolescent, our bodies are very dynamic, changing daily as we grow. At 19y/o perhaps her growth spurt is over, she may be skeletally mature.

If she is skeletally mature, further progression of the problem should slow and possibly stop.  But, slow progression, or stopping at this point is still not acceptable.

Ask your family Doctor of Chiropractic, or orthopedist for an xray evaluation to evaluate skeletal maturity.  

Perhaps if the bones have reached maturity, and are not still growing and changing so dramatically, a re-evaluation by an orthopedic surgeon(s), or a thoracic surgeon(s) could be helpful.  If the chest is that 'deformed', there may be help through further surgery to 'straighten' and approximate the sternum and ribs.

This would be a difficult case for a Chiropractor (or any doctor) to take on.  Your daughter apparently has severe problems.  Lifesaving heart surgery left her with this orthopedic skeletal condition.  Unfortunately doctors of all disciplines are reluctant to take on cases complicated ("caused") by other doctors, for fear of being caught in the crossfire of possible malpractice.  This is especially so for the Doctor of Chiropractic.  You have a complicated case (obviously) in a young person that may or may not result in a good outcome.  You have a case where the ribs pop in and out quite readily and easily- causing pain.  You have a case where IF Chiropractic does hurt during the treatment and even IF it is helping, many americans are impatient and litigation prone; many doctors, including Doctors of Chiropractic will be reluctant to go near your case.  I am not proud or happy about this, just reporting what may be in the doctors minds who decline the case.

That background being given, I would attempt to find a Doctor of Chiropractic (DC) who would be willing to evaluate and perhaps treat the case.  The body is a wonderful organism, capable of healing from terrible conditions.

I would look for a DC with some type of additional training.  For instance I have a diplomat in sports injuries (DACBSP see ACBSP.COM). There are 'specialties' with diplomat status in orthopedics, rehabilitation, neurology, nutrition, radiology and others.  I would look for a Diplomat in Ortho, Rehab, or perhaps Neuro.  One of the approaches I would recommend would be 'Kinesio taping'.  PERHAPS some treatment could be followed by kinesio taping the joints (rib-sternum junction, other involved joints) with this kinesio tape technique.  This supportive 'brace' could help hold the joints in place, allow healing to take place, yet allow movement. I know the costochondral (rib- sternum) junction is particularly culturally sensitive spot (young ladies chest), but this is an approach that MAY have some help/ hope for the condition described.
Doctors of all disciplines will act professionally, and if your daughter is especially modest about this technique suggestion, perhaps you could find a female DC with the above qualifications.

I know it is a chronic, constant, mechanical problem, and nutrition may not seem like an answer.  We americans often make our pain and conditions worse by living a pro-inflammatory lifestyle.  Certain anti-inflammatory supplements and an anti-inflammatory lifestyle would be helpful to reduce her pain and inflammation.

Pro-inflammatory: smoking, alcohol, caffeine, lack of movement, inadequate rest, Standard American Diet (SAD), processed foods, artificial foods, fast foods.

Anti-inflammatory:  Fruits, Vegetables- fresh, raw, organic, fresh pineapple everyday, bromelain, proteolytic enzymes, glutamine, vitamin C.

You do not have an easy row to hoe. I wish you luck in trying to resolve this difficult condition. I hope my suggestions help, or initiate a thought process towards help.

As always, this article is for discussion purposes only; information and education. Specific evaluation, DX, TX, RX, PX can only be given by treating health professionals.

Wishing you Good Health Naturally,

Victor Dolan, DC DACBSP
http://www.DocDolan.net
http://www.GoodHealthNaturally.info