Last weekend, a colleague of mine called me because her husband had severe "rib pain," so I went to take a look at it. Apparently about a week ago he developed pain in his R chest and back but significantly worsened earlier that day when playing basketball with his daughters. The pain was located pin point at sternal end of 3rd rib and some mild pain at vertebral end as well. The pain was constant but had a significant increase with transfers, rolling, and laying on his side.
Cervical AROM had a slight increase in pain with rotation but no change with flexion and extension. Mobility was moderately limited with all motions. Thoracic rotation was mildly painful and BUE myotomal strength was 5/5 throughout. Pinpoint tenderness was noted over the R anterior 3rd rib near the sternal attachment. It "appeared" anterior and hypomobile relative to the surrounding ribs, but testing like this has pretty poor diagnostic capability.
I did a thoracic, rib and CT junction manipulation. The patient was instructed to do some general thoracic/rib mobility exercises, use various methods to address the pain (OTC pharmaceuticals, heat/ice, gradual increase/resumption in activity). I educated the patient on the fact that injuries like these can be painful initially, but they do get better typically quickly.
It's important to stay away from pathoanatomical diagnoses as it can make the patient think they are fragile. While I referred to the case study as "rib dysfunction," I do not and cannot know if the rib was truly involved, even with how abbreviated the examination was. My goal was to lower the threat level by introducing motion to the involved areas. Once the restricted areas were identified, lowering the threat level was done through education, manual therapy and exercise. The key is to guide the patient through the painful experience, by being a resource and assisting self-management for addressing the injury.
-Dr. Chris Fox, PT, DPT, OCS
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