Question
Hi, about a year I started having a bloating feeling in my upper right abdomen. Over the course of the year I have had ever GI test possible with none of them showing anything. Now the doctors are wanting to take out my gall bladder just to see if that's what it is. I have had some digestive problems but nothing severe. However, what I'm most curious about and what the docs have listened to the least is that within a few days of all these problems start, my rib started popping in and out in that same area. It is the first rib that isn't attached to the sternum. When I breath, sit, or lay certain ways the tip of if it pops out and comes up on the rib above it. It doesn't produce sharp pain or hurt really bad, so I don't think it's on the nerve, but it is extremely uncomfortable all the time and has my whole body hurting because I stand and sit crooked without even thinking about it. I don't know why it happened and what I can do to fix it and how much of my problems are related to this. It feels almost though as if there isn't even enough space for it to be in it's original place when I bend certain ways. I don't know what's happened or what to do. I have delayed the gall bladder removal, and have also delayed an intercostal injection simply because I don't think it's on the nerve. Any advice would be greatly appreciated. Thank you.

Answer
Jared,

I am sorry about your pain. Unfortunately, it is impossible for me to give you a reliable diagnosis or treatment option over the internet.  It wouldn't be prudent on my part, so I must tell you that everything that I say is pure conjecture.

First of all, I have never, in the 25 years that I have practiced, seen a rib that dislocates and bumps into another rib.  I am not saying that it is not happening in your case, I am saying that I have never seen it happen...  If this is truly the case, then perhaps you need to consult an orthopedic doctor (bone and joint specialist) to see what he/she could do.  Normally there are 2-3 inches space between the ribs when they come off the spine. If it is, as you say, your 12th "floating" rib, it should not be in contact with any other rib.  The truth is, the rib is NOT floating. It is encased in muscles and ligaments (have you ever eaten ribs? the meat is the muscle that encases the rib). It is only called a floating rib because on x-ray you can't see all the muscles and the connecting tissues.

If the rib is truly dislocating and positioning itself on top of the rib above it, I can't think of anything short of surgical removal of the rib that would cure this.  I must be honest, however, in telling you that I have my doubts that the rib is truly dislocating.  It is much more likely that you are experiencing thoracic/lumbar degenerative changes, with altered mechanical function of the rib, thus irritating the muscles and nerves between the ribs.  Thus, I would give the intercostal rib injection a try and see what happens.  You might also try a chiropractor to see if he/she could calm the region of the spine and ribs down with therapy and/or adjustments.  (make sure though that you do not have osteoporosis. If the bones are weak, a fracture could occur... your chiropractor should take this into consideration as he/she evaluates you for therapy.)

I know that this is not a perfect answer... but I hope that at least it gives you some thoughts. For me, in my mind, surgery is the last option. It should only be done after everything else has failed to help. I would be reluctant to have the gall bladder out if there is no diagnostic evidence that indicates that it is infected or causing your discomfort.  Read up on gall bladder symptoms on the internet, and see if in your mind you match what other people are feeling when their gall bladder was bad.

Good luck,

Keith Biggs, DC