Expert: Dr. Victor Dolan, DC, DACBSP - 4/26/2009

Question
Hello Dr. Dolan, I will make this as brief and to the point as possible. My son has been suffering with rib pain on his left side for 18 months. He also has upper back pain which started about 8 months ago. The 3rd rib left side of chest causes him extreme pain when he runs. The pain in his upper back also seems to be the 3rd rib and it has become a constant pain. The back pain is much less than the rib pain. He can run 1/4 mile and has to stop because of the pain in the chest rib. His back doesn't hurt more when he runs. He has been to every specialist we can think of. He has seen a cardiologist (all good), an orthopaedist, doctor of osteopathic medicine, tried acupunture, had two steroid shots in the rib where it meets the sternum (they didnt help at all), he had a stess test, bone scan and two mris of the chest. The bone scan and mris were clean. None of these doctors agree on whether the back pain and rib pain are two separate issues or are they connected. All of his tests were on his rib, the doctors all focus only on that since it is his major complaint, since he can not run because of the pain. The only possible clue to the rib pain, is that when he had the sonogram guided steroid shot 3 weeks ago, the doctor performing the sonogram said the third rib in his chest was chipping. We don't know who to go to next. Someone who will fix the chipping rib or address the back pain. From reading your answers it sounds like it could be a rib problem in the back, causing the pain in the chest. But could the chipping rib occur because of a problem with the back? Do you think seeing a chiropractor would be his best move at this point? As far as the cause of the pain that is another mystery. He was working out everyday and running about 7 miles with no problem just before he started getting the pain. Any help/advice will be greatly appreciated.  Thanks for your time, TS

Answer
back pain, rib pain, 'chipping' rib




Hello Theresa,

Sorry to hear of your son's complaint.

You do not mention your son's age.

You do specifically locate the pain:  3rd rib, left side.
Who has given this pinpoint location?- Doctor's ,,, trainers who have examined your son?

"....He has been to every specialist we can think of. He has seen a cardiologist (all good), an orthopaedist, doctor of osteopathic medicine, tried acupunture, had two steroid shots in the rib where it meets the sternum (they didnt help at all), he had a stess test, bone scan and two mris of the chest. The bone scan and mris were clean. ...."- very thorough.  Good,,,, ruling out all of the MEDICAL pathology stuff.

The steroid shots were (in my opinion), kind of worth a try,,,
but the steroid anti-inflammatory shots are still treating symptoms, not causes,,,,
    and steroids can cause their own problems- allergic reactions, bone/ tendon/ ligament deterioration at the site.

".....the doctor performing the sonogram said the third rib in his chest was chipping. ...."- chipping?  What do you/ the doctor mean by 'chipping',,,, is there some kind of bone fragment?, joint deterioration, degeneration??  If my answer is not sufficient, if you re-contact me- I'd like to know your son's age and the meaning of 'chipping'.

You have been to the Medical Doctors, the 'specialists', had a ton of tests; all negative except now for a 'chipping' rib.  You have been to the Medical Doctors and probably run a gamut of treatment (meds) and therapy.

This ^^ above is not a bad thing,,, you have ruled out the big bad medical pathologies- ie: left chest pain????= reflex, think heart!, you have ruled these bad things out.  Good.

I am a Doctor of Chiropractic.  I am a DACBSP- a CHIROPRACTIC sports injury specialist.  I will UPFRONT admit my bias:
         Yes, you should see a Doctor of Chiropractic (DC).

You have tried various specialties in the Medical Doctor arena, why the reluctance to try a specialty in the Chiropractic Doctor arena?
         Yes, there are specialties within the Chiropractic Profession- please see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf

Given your son's history/ complaints:  I would recommend a Doctor of Chiropractic for an evaluation.  If possible, I would recommend a DC with additional sports injury credentials, orthopedic, or rehab credentials.


Using  http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf  you could probably google the different Chiro organizations and their credentialed doctors.


Yes, the pain in the back and the front of the thorax ( the chest area) is connected.  One is causing the other, one is allowing perpetuation of the other.  Sports injury chiros, ortho, rehab chiropractors will evaluate front and back, and IF INDICATED provide treatment- perhaps adjustment front and back, front only, back only.  Only in-person physical exam by a DC will elicit the proper maneuver(s).

You have done a good medical workup, now I think it fair to do a chiropractic workup.

Bring ALL of the information you can gather to the Chiropractor when you go for that examination.

I have a sports injury chiropractic practice in my Staten Island Chiropractor office.  It is a little frustrating that people often come to us last in their treatment protocol- after a lot of wasted time and effort- yet it is also often satisfying to find a 'chiropractic lesion' that can fix their complaint; and I feel secure it is NOT a 'medical lesion' after those thorough workups.

I hope I have given you an answer.

I hope this is helpful.

If further is required- please re-contact me here at AllExperts.com
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm

I wish you good luck and good health for your son,

Dr. Victor Dolan, DC
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Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine