Question
My girlfriend plays legitimate roller derby, an unscripted full-contact sport in which people are injured in very real ways.  Four days ago she had a series of falls and a pain in her back, near the spine and under the shoulder blade on the right side.  The next morning the pain was excruciating and she said she could feel things moving at the point near her spine and under her shoulder blade.  When she felt along her right side, thinking it may be a rib, she felt a pain wrap around to her front near her sternum.  She went to a chiropractor who took an X-ray from the back only.  He said he couldn't see that anything was broken and he said that maybe her rib was just out of place.  He put pressure with his finger tips near her spine, trying to feel what might be wrong and something shifted so that the pain shot around to her sternum and side and was more intense than it had ever been.  She couldn't use her arms because of the pain.  He said that if it still hurt that bad in two days to come back.  Two days later, the pain is somewhat lessened and it is centered at her side and under her right breast but not all the way up to the sternum.  Moving in certain ways or pulling on things with her right arm can cause a shoot of pain suddenly.  She wears a wrap which seems to help and manages the pain to a degree with over the counter pain killers.  She has not been back to the chiropractor.  

My concern is that there may be something that needs to be properly placed for her to heal well.  Could she have breaks or tears that require certain treatment or attention?  Is it alright for her rib to have shifted like that and caused so much pain when the chiropractor applied pressure but wasn't necessarily trying to make an adjustment?  What's a good next step?

Thanks very much!

Answer
Hi William,

I understand that Roller Derby is making a come back!   Your girlfriend likely does have a cracked rib.  It is very difficult to see rib fractures if the x-ray quality is poor, if there are too few x-rays taken, or if there is only a hairline crack.   Most in-office chiropractic x-rays sytems are substandard (IMHO) because they don't get used enough and the chemistry gets stale, or the system is not as strong as the hospital x-rays.  Hospital systems are called triple-phase and they can get better penetration with smaller radiation dose.  Most systems also now are digital: no films or chemicals, making it easier to look on the computer image and zoom in.   A dislocated rib should be pretty obvious to the doctor, and ribs "out of place" are not very likely. Cracked/fractured ribs are not so obvious, vis. they do not stick out very much.  I'd suggest that she get a second set of x-rays, and if rib fracture is ruled out, and if she still has pain that does not improve, then a second opinion via a different doctor (look for a certified sports chiropractor at www.acbsp.com) might be a good idea.

'Hope this helps.

Dr. G