Expert: Scott F. Gillman, DC, DACBSP - 7/12/2009

Question
Hi I was treated for Tuberculosis last year and I originally had sharp pains which disappeared with my tuberculosis treatment but I had this sharp pain in my right ribs when I tried to breathe, so I couldn’t almost breathe. One morning when I woke up I knew I had pain so refrained from even trying to take a breath, I used my nose instead to breathe. When I got up, I stretched my arms up and I took a full breath and I felt my right ribs crack in. It was like they had been pushed or pressed in, and ever since then I haven’t been able to take a full breath. When I wake up I felt the pain on a short breath. Sometimes when I try my best to take a full breath I feel the pain directly behind my ribs in my back but I suspect this is referred pain. I also experience my right upper chest tightening and the hospital say this is because I'm not taking a full breath. Last December I had a CT scan and nothing abnormal was found except this: "In the thoracoabdominal region, there is some asymmetry of costal cartilage with some concavity on the right side.this presumably may have resulted from past trauma and be giving rise to mechanical chest pain" I also had an ultrasound scan and MRI scan and there was nothing found. I was on painkillers for a long time and they weren’t helping so I stopped taking them and now they way I’m surviving is just drinking hot water and using a hot water bottle at night. Without this I can’t breathe properly. The breathing pain in my right ribs sometimes radiates to the middle and very frequently I experience a small pain in my left ribs but that is nothing compared to the great pain in my right ribs. Can this be fixed in any way? I can’t sit or stand properly because the pain is too much. I want to know if the concavity in my right side found in the scan can be fixed? I still feel this whole right side pressed in and I can’t take a full breath and at times not even half a breath. It has been One and a half years and I’m still in the same situation, stuck in the house and limited in my activities because of my pain. The orthopaedics specialist said nothing really but just inflaming of the ribs and he sent me to the pain specialist who I saw in March 2009 and he didn’t check me thoroughly and is going to give me an injection in November 2009. I also want to know if the injection is necessary for my pain. It’s very complicated but please help me. I will really appreciate it. Thanks.

Answer
Babar,

The rib cartilage asymmetry likely has nothing to do with your pain.  The fact that a hot water bottle is alleviating and that an interventional pain management specialist has some target in mind regarding injection seems to point to a musculoskeletal cause for your pain.   If you have not tried any manual therapy, be it physical therapy, massage, or chiropractic, then you owe it to yourself to go down this path.  If your pain is from myofascial adhesion, then a DC or massage therapist must work through that tissue.   If you have stiff and stuck joints driving your pain or promulgating the fascial lesions, then you must try chiropractic joint manipulation.  If you haven't tried these avenues, then you must consider them.  The chiropractors are the most and best trained in joint manipulation.  

Good luck.

Dr. G