Question
Hi,

Back in the fall of 2008 I was performing a stretching exercise that involved twisting my rib cage. While performing this stretch, a sudden loud popping sound came from my sternum area followed by excruciating pain. The "pop" knocked the wind out of me causing me to cough. The pain quickly subsided and it didn't seem like anything was wrong (I didn't notice any pain or problems afterwards). Then a couple months later, I slipped on some ice (both feet went up into the air) and I landed directly onto my right elbow and lower right lumbar area. I was sore for a couple days, but again, nothing seemed immediately wrong. A month or so later, I started to get weakness down my arms and tingling in my hands. My heart began to race and I felt flushed. I had to sit down. The feeling eventually passed. My doctor passed it off as anxiety (even though I am not a very anxious person).

Ever since these two accidents, I have been experiencing these symptoms and they slowly have gotten worse and worse over time. I began to experience dizziness or a detached feeling, and I couldn't focus. I started to have visual disturbances which my optometrist thought were silent migraines. Early this year, my symptoms became completely debilitating. I was having full blown migraines. The weakness and tingling in my arms was getting to the point where I had to switch arms to drive with whichever one felt "less weak". Driving became unbearable. I began to feel spasms going up my neck. My entire neck felt hypersensitive and it got to the point where I could not hold up my head or turn it without a terrible rush of nerve pain right after. It has been nine months of investigation and tests. I cannot do any activities anymore. Writing, sitting, driving, house-hold chores, shopping, anything that involves the upper body. I have to sit in a reclining chair. My hands constantly shake and I can always feel the muscles pulling in my neck and shoulders. Even when I am at complete rest my muscles feel constantly "On" and strained. Sometimes, the feeling spreads into my rib cage and pectoral muscles. Sometimes it feels like there is a weight hanging off my sternum. I have also noticed that I have a rib on the left side that seems popped out quite a bit more than its mate on the right side. I had pain in my chest as well but nothing is wrong with my heart. The worst areas are all right sided; shoulder blade area, up the back of my neck, all down the right side of my neck, into the area just above my right clavicle and the upper right pectoral area.

I visited a chiropractor and he found joint dysfunction at T2-T3 and at T3-T4 and dysfunction in my neck (He did not look at my ribs/sternum). I was getting adjusted weekly for months and it was not helping in the least. It was discovered that even after being adjusted, my T3 vertebrae is still rotated and the joint just locks up again in a short as a day. I have had X-rays of my spine (normal - mild upper lumbar scoliosis of 7 degrees) a bone scan (normal), brain MRI (Normal) and a cervical MRI(showing para-spinal muscle spasm, loss of curvature, mild disc bulging but no nerve impingement). From the test results, the doctors don't believe there is anything seriously wrong. I have done physiotherapy, acupuncture, massage therapy, decompression treatments, taken medication for migraines, muscle relaxants, and nothing has helped give me any relief at all. Upon seeing another chiropractor, it was found that my posture exhibits a dropped right shoulder and my head is tilting to the left to compensate (this was also evident in the bone scan and x-ray pictures, but none of the doctors commented on it) I know my posture was NOT like this before my accidents. The chiropractor also agreed that there seems to be an issue with the rib being notably more popped out on the left. I keep bringing up the "popping" incident or the fall on the ice to my doctor, but I think she has given up on me.

Is it possible that I did damage to a ligament in my sternum area? or possibly my clavicular joint when I landed on my elbow? There is nothing visible on x-ray, but I have read on the Internet that if the injury is anterior or posterior, it wouldn't show on an x-ray. I don't know what doctor would specialize in something like this. An Orthopedic? It really does feel like I have an instability and my muscles are taking on the added strain. I literally feel strain all the time no matter what I am doing and if try to do normal daily living activities, the muscles just get tighter and tighter and spread up under my jaw and the base of my skull until I get debilitating migraines that even my preventative medication doesn't keep away.

Any information or direction you could provide, I would really appreciate. I am losing hope. I am in my late twenties, and the thought of having to live like this, suddenly makes life seem... too long.

Answer
Hi Callah,

You need to have a consultation with an interventional pain management specialist.   These are MD's that specialize in treating pain.  They are often MD Physiatrists or Anesthesiologists.   You also need to go through a depression screening, since depression can be an underlying cause of pain or pain that is chronic or not resolving.   You may have what's called "Centrally Mediated Allodynea," which means that your brain has become hypersensitive, and normal stimuli from your body is processed as painful.   This is a real phenomenon.    Fibromyalgia syndrome is a type of centrally mediated allodynea.   These conditions can be developed after a series of traumas.   Lastly, make sure you have normal vitamin-D levels in your body, since D deficiency is associated with muscular weakness, bodily pain, and depression.    Your serum D3 level should be 50 at minimum and 85 at best.      I would suggest you start with a blood test for D3 levels, then make a consultation with the pain management specialist.   Run this information by these doctors to get their opinions on my comments.    Hang in there.   There may be a simple answer for your problem.  

Best regards,

Dr. G'