Expert: Dr. Victor Dolan, DC, DACBSP - 9/12/2008

Question
My son has had a pain under his left rib cage and back every time he lays down, his condition is over one year now. He had been in the service for the past seven years. Last year he did a tour in Iraq, and was involved in several road side bomb attacks. Recently a MRI was performed on his lumbar spine, the results were, two compressed fractures, degenerative lumbar spine disk,arthropathy at L3,L4,L5,myofascial,post traumatic stress,sleep apnea,and depression. The VA doctors  cannot find the reason for the pain under the left rib cage. Do you have any diagnosis?

Answer
rib cage pain, pain, rib cage, MRI, lumbar spine, compression fracture, degenerative lumbar spine, arthropathy, myofascitis, herniated disc,

Hello Josephine,

Sorry to hear of your son's physical problems.  Thank you, and thank him for his military service on our behalf.  He is a brave young man serving in the military for our country.

To recount his diagnosis:

Two Compression fractures- old? new? caused by the IEDs? treated by the VA or field doctors?

Disc, herniation?  Degenerative Discs?- his age? did he play sports, ever injure his back before the service, and before the bomb attacks?

Myofascitis- muscle spasm, pain, trigger points, muscle knots- since injury in Iraq ?

Sleep apnea; is your son heavy? have other breathing problems: asthma, allergy?

PTSD, depression; certainly out of my expertise,,, all of this due to the military time- yes, correct?

Now, the Pain under the Left ribs:

You have a lumbar MRI.  MRI, CTscan, EMG, EKG - all of these tests only take a small snapshot of a specific area or function.  Besides the Lumbar MRI- have there been other tests?

For the pain under the left ribs I may want to see a lumbar MRI, THORACIC MRI, lumbar Xrays, THORACIC Xrays, Chest Xray, Chest/ abdomen sonography, chest/ abdomen CTscan, Bood tests, perhaps an EKG.

You say 'under the left ribs'; left side- up front? possible stomach or intestinal problem if inferior to the ribs; left side- under the ribs, superior to the bottom rib? possible SPLEEN, or even a heart or lung problem.  "Under the left ribs",- posteriorly? possible a kidney problem.   Pain is 'referred' and 'radiated'.  You need to better pinpoint the pain spot,,,, and even with an exact pinpoint- it may or may not be the closest organ to that point, or even related to that point, pain can travel, refer or radiate far from the actual cause.

Do I have a diagnosis? No. none at all. Pain under the left ribs just makes me ask for more information. Guesses- Spleen, possible stomach, possible intestines, possible left kidney.  Need more information, more testing- as above.

Is the pain worse on movement?  Does it hurt at rest? Does it hurt ALL the time? Is it worse at night/ day/ am/ pm ?  Does anything in particular that you do make it worse, make it better?  Does medication help? Have you used hot or cold?  Did this pain start at the same time as any of the other pains?

In my Staten Island Chiropractic office, from a chiropractic viewpoint, I may order some of those tests mentioned above, and would also investigate if the pain could be coming from the spine (heniated disc, musculo-skeletal cause, rib cage misalignment).  But I would have to do a thorough evaluation to rule out any organic/ metabolic cause of his complaints.

I hope this helps.  First rule out any organic/ metabolic problems with the tests above.  Then- because of the multiple trauma, perhaps look into musculo-skeletal causes of the pain.  Your local family Doctor of Chiropractic could be helpful, or the VA should be more thorough themselves.

Good Luck, and I wish you Good Health Naturally,

Dr. Victor Dolan, DC
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