Question
QUESTION: My issue is pretty complicated and I have been trying to figure out where to turn.

2 1/2 years ago my back started getting really tight in between my right shoulder blade and my spine.  The tightness soon turned into pain that I had never felt before.  It almost seemed like I needed a massage when you get a really good knot in your back, so I decided to try and get a massage at least 3 times a week.  The pain kept getting worse and worse and it got to the point where the massage therapist touched my back and it hurt so much to the point where he did not want to massage me.

A few days later at work I felt and heard a snap in the area in between my shoulder blade and spine and lost all my strength in my right arm.  The pain shot from my shoulder blade area all the way to my fingertips.  The pain was so terrible that it made me sweat.

I was taken to urgent care and was examined and was told that I had multiple back injuries that a rib popped out.  An x-ray was taken of my scapula and everything was fine.  I was placed on light duty for 3 weeks and returned back to full duty.  About 1 1/2 months later the same exact thing happened to me.  There was a snapping sound that I felt in the same area in between my shoulder blade and spine on the right side of my back.  I was taken to urgent care again and was told that I sprained my back and that a rib popped out.

I decided to go to my personal doctor and he ordered x-rays of my back.  They noticed that my right side of my back was swollen and also found in the x-ray that I had fractured a rib at my T6 level about a quarter inch away from my spine.  I was referred to PT and 3 months later the rib healed and this is where it gets interesting.

I still had a great deal of pain in the area and was sent to take an MRI.  The MRI showed nothing unusal:

L2-L3 1mm bulging disc
L3-L4 1mm bulging disc
L4-L5 1mm bulging disc
L5-S1 2mm bulging disc

Minimal bone spurs on L2, L3, L4.  All of which I was told was normal.

My personal doctor diagnosed me with chronic low back pain and I was referred to an orthopedic surgeon who diagnosed me with chronic muscle skeletal pain with no known etiology.


On my last visit to a specialist and he found on my fracture on my T6 rib that was close to my spine was curved and did not heal correctly.  The doctor said that this was a problem that I would have to deal with.  Now is there anything I can do to eliminate the pain or make the pain a little less painful?

ANSWER: 2 and 1/2 years ago did you have trauma or some kind of injury?  Have you had a thoracic MRI?  You may have a degenerated disc at the level of T5-6 or T6-7.  As well as a nonunion fracture of the rib. I see you have the results from a lumbar scan.  Did your doctor believe your mid back pain was connected to the lumbar spine?  The lumbar disc bulges are large enough to cause a chain spasm in your back.  But the main problem is obviously your ribs and thoracic spine.  Have you had any lab work to rule out inflammation or arthritis?

I will need a few questions answered.

Thanks,

Dr. True



---------- FOLLOW-UP ----------

QUESTION: Dr. True,

Interesting that you bring that up about degenerative disc, because I have mild disc degeneration at the T7 level of my thorasic spine.  The rib that the T6 level did heal abnormal and the wording that the doctor put was that the rib now has a "curve" close to the spine.....not sure if this is good or bad.  The orthopedic surgeon told me that this should not be causing me any back pain though.

I have had lab work done and arthritis was ruled out and they are going to be checking for inflammation at the VA Medical Hospital, because my orthopedic surgeon said that any kind of nerves that were maybe getting pinched causing inflammation would have shown on the MRI.  

The doctors at the VA Medical Hospital found this to be a little odd that my private insurance did not want to have me tested for this.  They have set up an appointment for an EMG.....to see if any nerves are getting pinched.

Now, would having mild degenerative disc disease cause a rib to fracture?  The only thing that I can actually think of is the chiropractor that I was sent to that may have broken my rib!  Then again my doctor said that they only possible way for that to happen would be to have some kind of bone disease or tumor, which were all ruled out as well....so, would having degenerative disc disease cause a fracture?

Answer
A rib misalignment could certainly cause severe pain. It is unlikely that a chiropractic physician could break your rib. Unless as your other doctor suggests, that you have an underlying bone disease. In general chiropractors are amazing for treating rib type pain. I would look for a different chiropractor, the chiropractic doctor you saw may not have correctly diagnosed you.  It is very common that a minor misalignment of the rib articular surfaces will become worse over time eventually cause a stabbing pain in your back.  Just as your experience with the chiropractor may not have resulted in a correct treatment, your current management plan is questionable and probably off base. If you are having mid back pain and you know you have a degenerated disc, its not rocket science that you need an MRI of the thoracic spine. Or at least at minimum, a though musculoskeletal evaluation of this region. There may be an economic reason not to have an MRI, but academically no one in the room at this point has provided the correct diagnosis. An EMG of your legs and arms may give some indication of the extent of neurological involvement, it is poorly localizing.  In my experience as a chiropractic neurologist I have lost count how many thousands of patients with similar symptoms have passed through my office.   The symptoms described could be a neurogenic thoracic outlet syndrome (TOS) from the rib misalignment. The problem is, most doctors are unfamiliar with this disorder or they are improperly trained in its diagnosis. This not a vascular problem as many physicians may tell you. That is a different type of TOS. Hence the problem finding a doctor familiar with your problem.
Specifically you may have a scapulothoracic dyskinesis causing TOS. There are other reasons for your condition that should be investigated. But if you doctor is unaware of that term, you may be well advised to find another physician. There are multiple disorders that should be investigated including cervical degenerative disc disease and root compression. Please let me know about the EMG results and any diagnostic conclusions.