Expert: Scott F. Gillman, DC, DACBSP - 6/26/2008

Question
Hi Dr Gillman,
I have been everywhere looking for an answer to my problem...to no avail.  I sure hope you have some insight.  In Spring '07 I was in a dirt bike accident.  Nothing too severe, but I did tear up my knee pretty bad.  While waiting for my appointment with an orthopaedic dr (and on crutches), my knee went out and I fell on my left side onto a driveway...... and broke my elbow.  Very painful.  I was in PT and OT for a long time for each problem. After I was able to finally roll over and not sleep only on my back I noticed my chest and ribs were sore.  Maybe I was feeling it now, partly, because I stopped taking all the pain killers at about the same time.  Anyway,  I could not lay on my stomach without a lot of pain. At that point it was specifically the Xiphoid Process that hurt.  I could put pressure there, and it was sore, but that was the only spot.  My Doctor took x-rays and thought it had a crack in it and said it protruded outward a little.  He sent the x-rays out and they came back that there was nothing wrong with my xiphoid or that area.  He then convinced me to go to the hospital to have an ultrasound of the area (of course after blood work, and sending me to have an EKG to check my heart at another facility).  His nurse called me back in a few days and said my liver enzymes were up slightly, and I needed to watch my diet and come see them in about 6 months.  Over time, my pain was accompanied by a popping sound or even multiple pops when I pushed on my xiphoid or my sternum.  Occasionally I have sharp pains in the chest area, but it all feels like a muscle outside or on my ribs.  Usually if I have been sitting, or have been leaning forward, and then straighten up it pops and hurts.  I was referred by a friend to a different doctor that was a few hours away from me, and I made an appointment and drove up there to see him.  I described my problem, he immediately said stand up with your back against the wall.  He pushed on my xiphoid, and of course it popped and I hurt.   He then told me that ligaments are torn in the area, that a lot of muscles, etc is subject to this kind of accident and that he suffered from a similar problem when he used to surf.  Then he told me that the good news is its not a major deal.  The bad news is that there is nothing anyone can do, and in about 10-12 yrs when you near 50, everything is going to become calcified and stiff, and it will most likely not hurt anymore because of reduced ROM. I live a very active lifestyle and I just cannot accept that this pain and popping is irreversible, and there is no treatment.  Looking online, you really don't hear much of this.  One other thing is that right before I was in that accident, I was recovering from a really bad chest infection with a horrible cough to the point I coughed up some blood.  It stopped bleeding in my chest within a day so my doctor said it was no big deal, it happens with really bad congestion and lots of hard coughing.  I thought I'd mention that because I was wondering about Costochondritis.  I do have pain (more of a soreness) in my chest area pretty much all the time now, it just gets aggravated when my sternum/ribs pop from me stretching back, or whatever.  Do you have any opinions?  I am self employed, with no insurance, and have been paying all these doctors out of pocket, so all these issues are about to break me.  what direction should I go in looking into a real solution?     Thanks you,  Greg

Answer
Greg,

I would agree that you somehow sprained the ligaments or injured the cartilage around the xiphoid and it remains unstable and irritated.  True, not life threatening.   It may be that the only way to kill the pain is to have small joint blocks, or injections, around the xiphoid.  But you really have to speak to an MD Physiatrist or MD Orthopedist or an MD Anesthesiologist that practices interventional pain management.  There also is Prolotherapy, which, while somewhat experimental, could be helpful and not harmful.  The physiatrist is one you can chat with about prolotherapy.   The only thing on the conservative and non-invasive side that I can recommend is low level laser therapy (LLLT).  LLLT cannot hurt you at all.  Find someone with a unit, also called "cold laser," and see if their unit uses at least one wavelength at 635 nm (visible red) as well as an infra red wave, e.g. 810 nm.   You can check out LLLT on this web site:  http://www.laser.nu/index.htm

What you've got is not easy to deal with, and I'm not aware of any literature on effective treatment, but the physiatry crowd may be more up on it...   Good luck with this.   I hope what I provided was helpful.

Dr. G