Question
I am a healthy 30 year old female.  I have never smoked, rarely
drink alcohol, and eat a very nutrient-rich all organic balanced
diet.  I have a job where I am driving for 4- 8 hours per day.  I
carry boxes daily and carry a bag on my right shoulder while out
of my car (approx. 1 hour/day).  I am very thin and have
extremely small bones.  I have never met anyone that wears a
ring size smaller than mine (size 2 wedding ring).  I am 5'9" and
weigh 115 lbs.  I have never been able to develop any significant
muscle tone.  (Dated a personal trainer when 23 years old and
had me on a intense weight lifting regimine for over a year.)  
Before my injury my only exercise was an hour walk with my
husband every other day.  My body can not handle much more
than that - feet and ankles swell and turn red if I try to walk
longer.  I had a seizure in the past and was sent to multiple
specialists - no cause was ever found. No problems with my
brain, thyroid, metabolism, hormones, kidneys, heart, leg veins,
etc.  I have had every medical test in the book.  Only thing ever
found was low potassium levels the morning of the seizure and I
always have low blood pressure which went even lower with the
seizure.

I currently have a fracture of my 10th rib where it is supposed to
attach to my spine.  I have already had a bone scan and am
waiting on a Dexa scan and a CT scan of the area.  I started
feeling pain in the area of the fracture while working but can not
determine the exact moment it happened.  It was minor pain at
first so dismissed it as a strain.  I continued to work and it now
has become very severe pain.  I am on Lidocane patches,
tramadol, & hydrocodone.  I am so small that there are no rib
belts made to fit me (28" chest diameter), so I have taken an
extra small abdominal binder and cut it up to make my own
compression brace that somewhat covers the correct area.  Even
with the meds I am in a lot of pain.

I think the fracture was caused by my heavy bag being on my
shoulder and how I have to jump and throw my weight into the
back of my SUV to shut the door about (15-30 times/day).  My
orthopedic doctor does not believe I could break a rib by
carrying a bag and repetitive motions of driving, etc (I have done
this work for 6 years).  I have known other small females with
my company that have pain in the same spot and helped it by
getting a rolling bag and lumbar support while driving and
therapy.

I also have other orthopedic problems that I know are from my
job.  Can not drive using my right hand due to a ganglian cyst in
my wrist.  Nerve pain shooting up the back of my driving leg
into my rear end.  My doctor also said I have scoliosis which was
never discovered during school checks as a child.  I also have a
strange bone that sticks out at the base of my neck that make
what I call "a hump".

My questions:
How long will it take before this horrible pain goes away?

Do you think my job functions can cause a fracture?

How do I prevent this from happening again?

Should I get a second opinion from another physician?

Is there therapy I can do?

Answer
Dear Katie,

Thank you for the indepth description of your functional anatomy and physiology in relation to the questions you have posed.  Very thorough!!

The pain you are experiencing at the rib can take quite a while to go away for a few reasons:  1.  That area of the body is in constant motion due to breathing, and rib fracture take longer to heal because of that. 2.  If the fracture is at the rib head where it articulates with the vertebra, there may be some cartilage damage as well, or the joint capsule may be inflammed, which will increase your pain. 3. It sounds as though you have a very high metabolism which requires more nutrients, this can slow the healing process if you are not getting enough nutrients for bone healing.  4.  Chronic pain can develop due to a thing called neurological wind-up, this is due to growth of paintransmitting nerves at the site of injury.  **Normal fracture healing takes on average 6-8 weeks without complications.**

Yes I think your job functions can cause a fracture... because of your stature. The repetitive stresses will normally cause muscle imbalance, deconditioning and microfailure of the ligaments which in your case could destabilize the area and predispose you to a fracture.  Now, it is not clear to me that you actually have a fracture...you said the bone scan is positive which is not specific for anything...it only lets you know that there is a metobolic process in the bones at that area (could be pathologic like cancer or just physiologic).  You need confirmation on x-ray or CT to confirm fracture.  The dexa scan will tell you what the levels of bone mineralization are (normal or reduced).  These tests are important to do at this time.

Prevention is fairly easy.  Once this problem is resolved, you need to alter your work duties.  buy a rolling bag instaed of a shoulder bag, when lifting you need to make sure that your form is perfect...always lift with your legs and a straight back...do not bend over, squat instead.  You also need to lift objects close to the body without twisting at the waist.  In addition, you need to check your protein intake and make sure that you are getting enough in your system everyday, and make sure your caloric intake is high enough...1500 calories minimum.

I think you should get a second opinion from a physician that will check other areas of your systems.  Hair analysic and saliva testing often finds physiologial deficiencies that are not found on blood tests.  You had stated that you have had every test under the sun since your seizure.  How long ago was that?  Do you have current blood work on thyroid hormones, pituitary hormones, and factors that are released fron the thalamus and hypothalamus?  You also need to have your adrenal function tested.  Much of this can be analyzed by saliva testing.  Chiropractors physicians and medical doctors do this testing.      -----Also, I think you need to have a thorough musculoskeletal examination from a good chiropractic physician for the scoliosis...what did it measure, was it a double or single scoliosis, and did it have a rotatory component?  Chiropractors trained in structural rehabilitation of the spine can reduce scoliosis and sometimes almost eliminate it. You can find information on technique and dcotors trained at www.idealspine.com.  I think you should wait on the lumbar support until you have you spine in that area analysed correctly to make sure it is what you need.

The hump in the back of your neck may need to be addressed as well, or it could be normal, let me explain:  The vertebra at the base of your neck (C7)is called the vertebral prominens because it sticks out further than any other vertebra in the spine (normal anatomy).  If you have a forward movement of the neck on the shoulders, this can be worsened though and fatty deposits can be laid down under the skin there due to metabolic/physiologic processes.  It is called a dowagers hump, but is not common in thin individuals.  Again structural rehabilitation can help this problem if it is the cause of the hump.

Lastly, I do not want to give you advise on any therapy you can do at home because I don't have enough information on body posture, you exact x-ray analysis, or examination of muscular function and fitness levels.  Without first hand knowledge of your body it is very difficult to design rehabilitation programs/exercises that will be correct for your functioning.  I really encourage you to follow up with a chiropractor to address these issues.

The bottom line is that I believe you have something happening in the endocrine system that is affecting your normal body processes.  This includes the thyroid, adrenals, hypothalamus, thalamus, pineal gland, and your sex organs.  The endocrine system will affect swelling, bone mineralization, fatigue, and pain levels.

Don't give up Katie, I know it is frustrating.  Feel free to follow up if you need to.

Respectfully,
Dr. J. Shawn Leatherman