Expert: Dr. J. Shawn Leatherman - 9/17/2007

Question
Many years ago I started having occasional pain in my left shoulder blade when sleeping on my back.  Breathing deeply amplified it.  Slowly it became more frequent to the point that it was happening every night when I slept either on my back or on my left side.  I went to a chiropractor, and the pain gradually moved down to the lower portion of my rib cage in back, and then wrapped around my back to the front right side of my ribs, like a fish hook.  For the most part it now is in the lower left portion of my rib cage in back as well as the lower right ribs in front, and only when I sleep on my back, stomach, or left side-basically if the left half of my body is touching the bed I end up in pain.  The result is that my right shoulder aches, and lately I get earaches and headaches from being on my right side all night.  It happens no matter where I sleep so it is not a mattress problem.  All pain pretty much goes away when I get up.  I use rib pain as a descriptor, but it doesn't actually feel like "bone" pain-more like right inside.  And while deep breathing will amplify it, it doesn't feel that internal (like the lungs), or even like breathing itself hurts.  More like by breathing, something is aggravated, if that makes sense.  My previous chiropractor had no idea what was going on, and I can't seem to find anything online.  I realize I should see a Dr but I am just wondering if you have any ideas about possible causes.  I would appreciate any and all ideas.  I am exhausted!  Thank you!

Answer
Dear Nikolle,

This doesn't sound like a "rib problem" to me, but rather a soft tissue problem such as inflammation of the joint capsule that surrounds the rib and vertebral articulation, the intercostal nerve, or a myofascial trigger point.  All of which can refer pain in the distribution that you have described.  The fact that the problem started in a local site and has generally gotten worse with pain traveling around the torso confirms these probable structures.

Other possible scenarios include gall bladder stones/dysfunction, shingles and pleurisy.  Shingles should easily be recognized by a rash on the torso, and can be itchy and painful...this is usually self limiting,,although anti-viral medication helps, and only last for a few weeks max in a healthy person.  Gall stones can also easily be diagnosed with clinical correlation such as (female, fat, forty, flatulence) and diagnostic ultrasound...another easy diagnosis to come by.  Pleurisy is an inflammation of the lining of the lungs, and is also easily recognized by a friction rub heard with a stethoscope when breathing.  An MRI can be utilized to confirm the diagnosis.  Moreover, all of these conditions should be easy to recognize by any chiropractic or medical physician.

So what should you do about it...I would suggest that you try to find another local chiropractor who is willing to address the issue from a myofascial standpoint to include some aggressive soft tissue techniques such as Active Release Technique (ART), Graston, or Sound assisted soft tissue mobilization (SASTM).  All of these techniques can be referenced online to include a listing of certified physicians around the country.

Concerning an MD, sure another opinion can't hurt, and a normal blood test can help to rule out other pathology, endocrine dysfunction, etc..., but this will likely not give you any more information about the nature of the problem if it is musculoskeletal.

I am not sure why your chiropractor didn't have any idea what was going on, because there are multiple structures that could be the initiating source of the problem. That being said, I still think that the problem lies within the myofascial system, and that is has gotten worse over time thereby increasing the symptoms you have been experiencing.  By the way, what was your chiropractor doing if they had no idea what was going on? Were you given a thorough examination of the area of complaint?  Were any orthopedic, neurologic, diagnostic or imaging tests performed?  Just wondering.

Hope this helps Nikolle.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net