Expert: Dr. J. Shawn Leatherman - 11/22/2006

Question
Hello there,
While I was pregnant with our son {4 years ago ] I had horrible pain in my right rib.He was almost 10 pounds and never dropped... he constantly kicked at my rib.. and I had what the Dr. called violent vomiting.. at least 4 -6 times a day.. which caused me to always lean on that right side while I vomited.. and put even more pressure on my right rib.i went to a chiropractor through out my pregnancy and even two years after.. but the pain is still there.. I even had IDT treatments on my lower back... {which helped a little } but nothing has really helped with this pain in my right rib.I have been in and out of the ER and they keep trying to say it is a "hidden gall stone " which I highly doubt.. it is my rib that hurts.. from front to back it hurts to sit up,lay down,etc. I apply ice everynight o n it so that I can fall asleep.. nothing helps.. not even pain killers... what should I do? do you think it is a broken rib? cracked rib? will it ever get better?
thanks for you time!
Leah

Answer
Dear Leah,

First of all I do not think that it is a broken or cracked rib.  You have had the pain far too long for that to be the problem.  Even though ribs are slower to heal, it would have healed long ago.

The issue of a hidden gall stone is a possible one, but gall stones usually refer pain to the tip of the shoulder blade as well, and an ultrasound should be able to find a gallstone even when it doesn't show up on an x-ray.  Things to consider...when physicians expect gall stones they should look for this profile...female, fat, forty, flatulent...the most common associated characteristics. If you match this profile, then I would get the ultrasound.

Moving on:  reading over the duration, the symptoms, location of pain, and relevant history you have provided, a likely diagnosis is intercostal neuritis.  This is a condition where the nerve that runs between the ribs has become chronically inflamed due to repetitive compression or microtrauma (baby kicking, violent vomiting)  Chronic muscle strain and scar formation in the area from former disruption can also cause intercostal neuritis.  If the cause of the problem is from the joints associated with the rib at the sternum and the vertebra, then chiropractic adjustments will help.

Unfortunately Leah, there is not a specific treatment for rib pain, or intercostal neuritis unless you have a break or dislocation, and even then treatment is fairly little.  Deep tissue massage over the affected area to mobilize scar tissue and break up adhesions may be effective in minimizing pain, but it will be very sore during the massage and usually for a day or too afterward.  You may also want to contemplate a local steroid injection from your medical doctor to reduce the inflammation which will also lower your pain.

It is likely that you will have to deal with continued pain along the rib for some time.  The best thing to remember is when pain becomes chronic, it will not disappear overnight with any type of treatment other than a complete nerve block.  I would recommend that you try the myofascial release work in the area 2-3 times and evaluate the effectiveness in reducing pain.  If that does not work, the steroid would be the logical next course.

Good Luck Leah.
Respectfully,
Dr. J. Shawn Leatherman