Question

I am desperately seeking information regarding a perplexing condition my husband has. My husband is an otherwise healthy 23 year old male. When he was about 15, and very fit, healthy and active, he developed a pain in his sternum that caused much discomfort, only relieved by stretching and 'cracking' his chest. He was unable to sit still and constantly moving and pressing on his chest to try relieving the discomfort. Soon after the pain developed he broke his collar bone playing football, only to have to hold his arm it still for 6-8 weeks while it healed. I don't think the bone set properly, and ever since he had slightly reduced movement, thus was less able to relieve his painful sternum. His parents took him the doctors who did various tests including x-rays, but mainly ECGs and the like, focussing on his heart and muscles, believing he had a cardiac condition. Nothing further was done at the time as their findings were basically inconclusive.

This year, his symptoms seem to have worsened and he has been to see a rheumatologist. The rheumatologist has done blood tests including CBP, ESR, CRP, RF, MBA20, HLA-B27 antigen, all of which were normal. A full body bone scan showed inflammation in the sternal area and x-rays showed a 'moth-bitten' appearance in the lower joint of the sternum (? errosion). After receiving these results, the rheumatologist ordered an ultra-sound and sternal fluid aspirate. The aspirate produced a result of a weak presence of staphylococcus warneri. He is now on a 6 week dose of antibiotics, as well as anti-inflammatories, and codeine for when it is very painful. He holds a wheat heat bag to his chest most of the time which seems to provide some relief. He has trouble sleeping at night as it is difficult to find a comfortable position, pain is not increased when he breaths, or particularly worse in the morning or night, and the only thing that really seems to aggravate the pain is simply being constricted and unable to stretch out or wriggle around to find a more comfortable position. The codeine does not help the pain and the anti-inflammatory hasn't made any difference yet either.

We have tried to research different conditions on the internet but have been unable to really find anything that fits all criteria and it is difficult to understand what might have caused the pain in the first place, other than maybe an injury sustained while playing football, basketball, athletics or any of the various other activities he was involved in. I have recently suspected this is what it is and years of stretching and wriggling has caused micro traumas that are aggravating it.

I have also been reading about the Grastons technique which looks like to might help?

Answer
Hi Anna,

It sounds like the rheumatologist is on the ball. A low grade bone infection causing osteolytic lesions would create a large amount of discomfort, not to mention the needle aspiration used to diagnose it.
I don't feel anything else is necessary, the antibiotics need to have time to work. The marrow is difficult for the antibiotics  to penetrate, that's why it takes so long. I admit osteomylitis (bone infection) is an unusual diagnosis since there is no apparent history of skin breach. I am glad it was caught when it was, otherwise these things can be very serious.
I personally am not familiar with Grastons technique but I have read up on it. It does sound like it will help mobilize the area the same way your husband had prior to the clavicular fracture. Since this afforded him some relief in the past, it would be logical to assume it would in the future.
Make sure nothing else is substituted for the problem at hand, the infection. This needs to watched closely to make sure the infection is susceptible to the antibiotic, many strains are resistant and require stronger meds. Please keep me up to date as this is a very interesting clinical case.
Thank you for sharing this with me and I hope everything turns out OK. I will be available in the future if you need a referral or advise regarding follow-up care.

Good Luck!

Dr. Timothy Durnin
drs.chiroweb.com