Adam Rufa - 4/6/2006

Question
I have been experiencing some right rib cage pain for about 4 months now. I first noticed the pain when I was jumping up and down on a mini trampoline for an aerobics class. I felt a sharp pain underneath my right ribs, just above my hip bone. The pain throbbed on my right flank for a day or so but went away. A week later, I noticed the pain again during a step class. I was jogging in place and again felt that right rib/flank pain. The pain has stayed with me ever since. It's a dull ache that I feel constantly. It has spread throughout my right rib cage, to my lower back. The muscles in my back seem to spasm now, which makes the pain worse. It spasms up the right side of my spine. It hurts worse when I'm sitting, and leaning back, and it also hurts worse when I'm exercising. I cannot exercise at all now. Even walking aggrivates it. It's hard to get comfortable when sitting down because it feels like someone is poking at my rib cage. When I wake up in the morning, the pain is gone. But within the first 5 minutes of walking around in the morning, and sitting down to eat breakfast, the pain starts, and gets worse throughout the day. What I eat does not affect it. I have also noticed a small lump on the end of my first floating rib. It doesn't hurt to push on it directly, but after pushing on it and poking at it, the pain gets worse and starts to throb. I'm wondering if the pain is generating from that? I've been to several different doctors, all of which cannot make a diagnosis. I've had numerous blood tests which have all come back normal. I've had 2 XRAYS, a bone scan, an MRI of my T spine, an untra sound of my abdomen, 2 cat scans of my abdomen (one with dye, one without) an unltrasound of my heart. I've also had a rectal exam and a pelvic exam. All tests were normal. Since none of the doctors I've seen are able to help me, I've been trying to diagnose myself. I've googled slipping rib syndrome, which has a lot of my symptoms. And I've also googled costochondritis. However, with that condition, one of the main symptoms is tightness in the chest, and I do not have any chest pain. But, this could also be due to the fact that the lump on my rib is on the lower floating ribs, toward my right flank, and not on the ribs that are connected to the sternum. Do you think it could be costochondritis or slipping rib syndrome? What else do you think this could be? I would appreciate any input on my condtion! Thank you.

Answer
Unfortunately I can not diagnosis your symptoms over the internet. I will say that there are many musculosketal problems that do not show up on blood work and imaging studies. My recommendation would be to find a good PT who can help you find a correct diagnosis (http://www.apta.org/AM/Template.cfm?Section=Find_a_PT&Template=/APTAAPPS/FindAPT...).
  Costrocondritis is a possibility however, this does not occur at the floating ribs. In my experience the floating ribs (ribs 11 and 12) usually don't sublux (slipping rib syndrome). There are muscles that attach to the 11th and 12th rib that if over activated during exercise may cause symptoms (quadratus lumborum).

  Good luck and sorry I can not offer you more help.