Expert: Dr. J. Shawn Leatherman - 2/21/2009

Question
Two - three years ago I was swinging a sledgehammer at work and i felt a snap in my chest that felt like a jolt of electricity.  For weeks after that the muscles around my my rib under my left pectoral muscle was swollen and I would frequently get sharp pains in my chest that felt internal.  The worst symptom that I experienced in that time was shortness of breath.  Every breath I took felt unsatisfying  as if I wasn't getting enough oxygen.  I went to a doctor for the pain and she said it was just a pulled muscle and it would heal in a couple weeks.  The swelling went down and the jolts of pain stopped but my rib still looked out of place and I still had severe shortness of breath.  I went to another doctor for the shortness of breath and he said it was stress. I don't have insurance so I just learned to live with it until someone told me that a chiropractor could maybe fix it.  I went my to my chiropractor and he explained what the problem could be but his treatment didn't really help.  Over the last few years there has been times where I felt great but the majority of the time there is slight discomfort and a frequent shortness of breath.  There is a permanent deformity in the cartilage on my chest.  Is it possible that this can be fixed and the shortness of breath will stop?

Answer
Dear Derek,

It is possible that you have a permanent deformity there.  The problem is that this was not addressed appropriately in the beginning.  If you tore the joint capsule that held the rib head into place at the sternum, this has to heal with scar tissue.  When the initial scar tissue was actively forming (first 3 months) that would have been the  most appropriate time to try manipulation to "reset" the rib head to its proper location at the sternum.  A full resolution of scar formation can actually take up to 2 years.  That being said, these mis-alignments are usually relatively small, however, really painful, ...it is not like the rib has actually popped out or the joint space (dislocated) it is likely just slightly out of position.  Chiropractic adjustments to the rib and sternum may still help at this point, but it will probably have a marginal effect.

Now, it is also possible that you did actually dislocate the rib head.  This would really need to be evaluated with a CT scan of the chest to specifically look at the sternum and rib cage.  Not to mention the lung fields, and scar tissue can all be visualized with this type of imaging as well.  I would actually recommend that you get the CT scan to verify what is the exact presentation is...this will give you the best information on what the most appropriate care program will be at this point.  If a dislocation is present, and this is a big problem for you, a surgical correction may be the best choice here.  The fact that you still suffer from shortness of breath is an indication that you may need more aggressive treatment. It really all depends on an accurate diagnosis.

Lastly if the rib is positioned correctly, then an overgrowth of scar tissue or adhesions is the likely issue.  If so, you will need to make the most educated decision you can with your doctor about the best way to go about dealing with that problem.  Again the car tissue can be removed, and so can adhesions...especially if the lung tissue is adhered to the anterior chest wall.  However, the risks of surgery may outweigh the benefits, and you have to realize that if scar tissue is removed, you will actually have to heal again with scar tissue at the site of surgery.  But, active motion exercises after surgery or myofascial work can help to reduce the post surgical scarring.  

If you continue to have pain with breathing, and there is scar formation, you may also want to explore Prolotherapy, which is performed with injections to the area to initiate a new inflammatory response which should help to reduce pain and chronic inflammation in that area.  That was a simplified explanation...you should look this up online for a better description.

Hope this helps Derek.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net