Expert: Scott F. Gillman, DC, DACBSP - 1/26/2012

Question
QUESTION: Hi Dr. Gillman,

I am a climbing arborist and five weeks ago I wrestled too large a piece of wood over my right shoulder while about thirty feet up in a large oak tree. There was no actual impact, just a large strain as the weight of the piece flipped me over backwards in my harness. I had a lot of pain, shortness of breath, and a half-a-tennisball sized lump right on the very edge of my rib cage. This lump is about five finger-widths down from where the ribs divide below the sternum. Now that the inflation has mostly passed the "lump" sticks up sharply from the edge of my rib-cage. Most of the tenderness is gone. But, I still have pain when ever I try to do anything that uses the muscles in my torso. I have not been to a physician mostly because I always understood that there is little besides rest and pain medication that helps rib injuries. I do see a chiropractor every two weeks. I am mostly wondering at this point if there are any bone/cartilage structure complications that could occur with this type of injury that would have long term implications. Could a rib or cartilage be dislocated in a way that would require more than just rest?

ANSWER: Brian,

You stated, "the very edge of my rib cage. This lump is about five finger-widths down from where the ribs divide below the sternum... the edge of my rib-cage..."    I am not clear exactly where the location of the lump is, based on this description.   It sounds like you are indicating that it is at the margin where your abdomen meets the ribs, in front of you and not on the side of the torso or ribs.    If the lesion is actually on the rib cage, it could be where the boney rib meets the cartilaginous rib.  This would be in a region about a few fingers width down from the nipple.  This interface, the costo-chondral joints, are a weak link and can easily be dislocated, especially as we get older and more stiff.   The abdominal muscle wall anchors itself to the lower ribs, and you could have pulled and torn this interface when you were launched backwards with that heavy tree limb.  This would be in a zone just lateral to the midline also by about four fingers distance laterally.     Costo-chondral joint sprains take several weeks to quite down and often resolve.    If you tore your ab' muscles, there could be a residual fleshy scar in the long run.    Either way, unlike fractures or tooth-cavities, it is difficult to predict with precision how it will heal in the long run.   If you have a rib fracture, and no other soft tissues around it got torn, then you will ultimately heal up well.      You should see what your chiropractor thinks about what tissues are torn/broken.    True, rest is best right now so long as you don't have any signs of organ damage (you can still breath...your'e not bleeding out internally...etc).     But after about a week or so, you will need to consider soft tissue therapy and exercises, depending your diagnosis.  

'Hope this helps.

Dr. G'

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Gillman,

Thank you very much for your help! You have the location of the injury correct: right on the edge of where the ribs and abdominal cavity meet on the front of my torso, and about 4-5 finger-widths down from the bottom of my sternum. The lump or sharp ridge sticking up from the normal surface of my rib-cage is hard, like bone, and does feel like it could be a "dislocated" rib or piece of cartilage. If the "costo-chondral joint" is dislocated, can it be relocated? I have no difficulty or pain with breathing at this point. When I do any awkward lifting I get an ache that feels like the pain is coming from underneath the injured rib.
This pain will usually last for several days. I will have my chiropractor take a closer look at this injury during my next appointment. Thank you very much, once again for your help!

Answer
Brian,

There is no chance of manually relocating any dislocated or fractured rib or cartilage.    You would obviously want to keep your torso upright, as bending down to tie your shoes in a sitting position (for example) will scrunch the ribs...    Frankly, you should get this x-ray'd just to see if there is a bone break or if it is just cartilage.  Cartilage does not heal over.  The broken cartilage will fill in fibrous scar tissue, and there is a likelihood of it always having a loose feeling after it is healed.    Get the x-ray first and get it checked out by your PCP or DC.  

'Best,

Dr. G