Question
Hello, I have been suffering from right sided pain for almost a year now. I finally found out
that the cartilage bridge of the end of my 10th rib has broken off. I am going to school to be a
fitness trainer and am falling so behind because I am unable to perform exercise of any kind,
even walking irritates this. The condition does not seem to be healing and I have seen several
different doctors, all of which have put me on different types of medications, which don't work.
I've been to 8 sessions of physical therapy and 2 sessions of injury massage therapy, which made
it worse. I've tried 6 sessions of acupuncture which did not help. I've tried resting it, I've
tried to attempt a little exercise, supplements, ice, heat, etc. Nothing is healing it. I've now
turned to prolotherapy, which is injections that are supposed to help regrow cartilage. If this
doesn't work, I'm considering surgery. But, I am wondering if surgery will even help me or how
it would be performed, I have no idea. Can you tell me if this condition is in fact curable?
I'd hate to think my fitness career is over! I've spent so much money on schooling and fitness
is my passion! I'd appreciate hearing your thoughts on this. THANK YOU.  

Answer
Dear Kristy,

You have a tough injury because cartilage is one of the worst structures in the body to undergo proper healing.  It has a very poor blood supply so when it is injured, nutrient delivery and oxygen for repair is slow and consequently degeneration happens more readily than healing.

Physical therapy for "broken" cartilage on the 10th rib is definitely the wrong approach in my opinion.  You cannot rehab cartilage...you rehab muscles and myofascial structures. For a cartilage fracture to repair it needs to be stationary like bone...when you break a bone you don't stress it, you immobolize it.  

The prolotherapy you are undergoing is the best approach in my opinion for your condition, although there is no guarantee that you will be able to heal the tissue especially after a years time.  Another approach you may want to consider is to get a cortisone injection in the area to reduce the inflammation associated...this will help in pain reduction, but it is not a cure.

Concerning the actual pain, if it is pinpoint over the rib articulation where the cartilage has broken, it is most likely from the inflammation and small nerve fibers.  If the pain travels around the torso horizontally you most likely have involvement of the intercostal nerve associated with the rib known as intercostal neuritis. This can many times be treated with an intercostal nerve block injection.  Common injection solutions include 3-5ml of 1.0% lidocaine(xylocaine), or .25% bupivacaine(marcaine).

Surgery for this type of problem can be just a simple proceedure of removal if there is a fragment, or a more complex proceedure of reattachment of the cartilage end to the rib.  Obviously the surgeon involved needs to make the decision on what is appropriate for the anatomy in question.  If other attempts as pain reduction are unsuccessful, I would recommend that you schedule an appointment to consult with a few surgeons to get a more informed decision on operative proceedures and their success rate for alleviation of your problem.

If surgery is your decision, I would recommend that you make sure your pre- and post-surgical nutrition include high levels of antioxidants as well as glucosamine sulfate 1500-3000mg per day,  M.S.M 750-1000mg per day, and chondroitin sulfate 1500-3000mg per day.  This will aid in the post surgical healing process.

Respectfully, Dr. J. Shawn Leatherman