Expert: Dr. J. Shawn Leatherman - 8/31/2006

Question
i have researched extensively on the back and and  shoulder problems that can occur. i was having sometimes pain near the medial scapula and long head of the bicep. i have done many many different planes of excersizes with the bands to try and stenghten or increase the endurance of the rotator cuff muscles. i was almost sure that i did have the labrum torn somewhat from the symptoms. As also no matter what i did try to increase the rotator cuff the problem remained. even when i got rid of all overhead presses. But to my surpise when i went to the chiro he told me that he does not think it is the labrum but the first rib that is out position. I have never came across this. Have you and do you believe that could be the cause? and Just what kind of movements would of caused this? thanking you in advance.

Answer
Dear JII,

The first rib can absolutely be a souce of pain and dysfunction when it becomes fixated, or the joint becomes irritated.  The anatomical connections are diverse because it joins with the 1st thoracic vertebra in the upper back, and joins with the manubrium of the sternum on the upper chest.  Not to mention that it also has numerous myofascial connections such as the scalene muscles which integrate it with neck movements  

The rib is classified as an atypical rib becuase of its differences in shape and articulation.  It is the broadest, shortest and most sharply curved off all the ribs.  It also has a very close relationship with the subclavian artery and the brachial plexus which supplies all the nerve function to the arms, the shoulder, and some to the upper back.  

I find that many athletes and active/fit patients that I treat have first rib fixations.  Symptoms can be diverse such as dizziness, tingling in the arms, cold hands/fingers, pain in the arms, upperback, shoulder and upper chest.  Most of the time, 1st rib fixation problems get immediate relief in symptoms after the first adjustment, which is a confirmation of the problem.  Sometimes the area is chronic and multiple treatments are needed to resolve the issue.

Although there is no definite cause to pinpoint for the problem, there are factors that contribute, such as:  forward head posture, throwing sports, rounded shoulders, hunched forward posture, tight pectoralis musculature, and tight anterior scalene musculature.  The best fix to the problem is the adjustment and postural exercises and stretching of the associated musculature.  In addition, any deformity or prior injury of the collar bone (clavicle) can have a contributing negative effect on the first rib due to their anatomical proximity.  {The clavicle rests directly above the first rib at the manubrium of the sternum.}

Concerning your possible labral tear, the only way to definitively diagnose the problem is with an MRI of the interior shoulder joint.  There are orthopedic tests that can be performed to aid in the evaluation, but the MRI is the gold standard for imaging and diagnosis.  Also if you do have a labral tear, rotator cuff exercises will help to stabilize the joint, but they will not fix the problem.  You may need to have the shoulder scoped by an orthopedist in surgery to remove any debris and/or repair damage.  

If the tear is small, then nutritional considerations such as glucosamine HCL/sulfate, chondroitin sulfate and methylsulfonylmethane(msm), will help the body repair the labrum, and you should rest the area...no heavy activity or workouts for a period of at least 6 weeks.

Please feel free to follow-up with any further comments or questions.

Respectfully,
Dr. J. Shawn Leatherman