Question
QUESTION: Hello, I am 19 years old and I have been dealing with constant back pain for around three years now. I have dislocated some ribs and in the last year I have partially cracked my acromion. The pain is always in the same spot, right under my shoulder blade, no matter what stretches, or how many times I go see a Chiropractor, it always bothers me. When I take a full breath, not only do I feel my popping in my back, but I get a sharp pains along the right side of my back. It's hard not to, but I constantly try to pop it this spot in order to feel more comfortable; most of the time it messes with my sleep habits. I can't sit still, the pain bothers me during school and during work. I am not sure what to do, my primary doctor basically just tells me the pain is in my head. Everyone says I am too young to be in pain, is there anything I can do, or can you possible tell me what's wrong?

Much Thanks,

Matthew

ANSWER: Dear Matthew,

I am so sorry to hear of your chronic pain. In your case, in particular, it is quite frustrating that the pain is so unrelenting at such a young age.

I cannot tell you what is wrong, in spite of the fact that I would really like to be able to. Diagnosis, when performed face to face, is difficult enough. Through text and email, it is impossible. I can give you some additional thoughts and ideas, however.

1) Make sure that this is a mechanical problem, and not something more sinister. Insist that your medical doctor evaluate you for infections and abnormal growths.  I doubt that you have this type of problem, but until all lab work is done, you cannot be sure.  Don't let your MD dismiss your pain as being all in your head.  Insist on tests to rule out internal problems.

2) How did you "dislocate" your ribs? did you actually break any of them?  Have you been evaluated for scoliosis?  When you hurt in the shoulder blade area, does your neck hurt as well? Sometimes upper mid back pain is referred from lower neck nerve irritation.

3) Is it possible that the acromion process of the scapula (shoulder blade) did not completely heal?  Have you had it re-checked?

4) Since the acromion is part of the shoulder joint, how is the strength of the serratus, infraspinatus, supraspinatus, teres minor, and subscapular muscles?  When you do a push-up, does your shoulder blade flair away from the chest wall on your injured side?  Have your chiropractor evaluate you for shoulder function, and strength of the muscles that support the shoulder.

I know that these are only ideas.  I wish that I had your perfect answer. Perhaps these questions will spark new thoughts and ideas for your doctors back home.

Good Luck,

Keith Biggs, DC
http://www.eastmesachiropractor.com

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

QUESTION: Thank you for the information, I appreciate that you took time out of your day to assist me! I never thought you could ribs could "dislocate" but that is what I was told by the ER and by the Chiropractor. In a soccer game, both me and another player were sprinting after the ball; for some reason he jumped up and his knee hit me in the ribcage. I immediately fell to the ground and had lost all control over my body. I could not breath, I felt as if I was a fish out of water. There is a good chance that I have fractured my ribs at one point, because I have received many blows to my ribs.  Yes my neck hurts as well, I realize it is bad but the only way for me to feel somewhat better is when I pop my neck back. I know this is counterproductive but it temporarily reduces the pain.

To answer your question about my shoulder, I never got physical therapy for financial reasons. There is a great chance that it hasn't healed because I cannot put much weight on it. I used to sleep on my right shoulder, but now if I roll on the right side of my body (while I sleep) I will wake up because of the pain. My shoulder is a lot weaker than it used to be, and it constantly pops and cracks during normal use. Doing push-ups is quite painful, but I am not sure what you mean by my "shoulder blade flairing away from the chest wall."

Do you think by explaining this to my doctor, could I finally be diagnosed with something?

Oh yes I have been checked for scoliosis but that was a long time ago. They said everything looked fine; that I have normal curvature in my back.

Thanks again for the help!

Matthew

Answer
All you can do is to continue trying. When the shoulder blade "flairs" from the rib cage, it is a sign of serratus anterior weakness, sometimes related to nerve damage.

The more that your doctor understands the nature of your injury, the more potential there is that he can help.

You also need to realize that some injuries result in permanent impairments. In other words, yes, you are young, but cartilage and ligaments never heal as well as the original pre-injury tissues. If you dislocated the ribs, this means that the integrity of the ligaments at the vertebral/rib joint has been compromised, torn, strained.  This tissue will heal but it will never be as good as the original tissue. Think of it this way. If you cut your skin, you develop a scar, right? The scar is never as pretty, is thicker, and the tissue is less functional. The same thing occurs when muscles and ligaments are torn or strained.

Good luck

Keith Biggs, DC
http://www.eastmesachiropractor.com