to my osteopathic brethren...

Hello... 2nd year med student here, with a muscoloskeletal question. I was hoping some of you DO students that are farther along in your training can provide some enlightenment here.

I've been having some pain in my ribcage for the past 4-5 months. Its not severe at all (maybe 2/10) and it feels for the life of me like an intercostal strain. On palpation, I can find a spot of focal tenderness, normally pretty close to the sternum. I really don't feel any pain unless I'm either: a) lying on my stomach with my weight shifted to the right side where the pain is or b) doing something that involves abdominal muscles (eg sit-ups).

To add to this, I began to have pain in my right pectoral region. Again, I only feel this pain when performing certain movements (generally movements that stretch the muscle). The pain does seem to be close to the origin of pec major near the sternum and there is a spot of focal tenderness. This feels to me like a strained muscle, but has lasted for about 2 months.

The rib pain seems to be relapsing/remitting and seemed to me for a while to be the product of weird sleeping positions. The pectoral pain is neither getting better or worse.

Now, the reason I'm taking the time to post this is that I am officially suffering from full-on med student syndrome. My working differential is as follows: strained intercostal/pectoralis, costochondritis, psychogenic pain, and tumor/leukemia (this is where paranoia sets in). I have spent the last few months furiously palpating for masses and have found none.

Now, my training in musculoskeletal is confined solely to a class in Connective Tissue path and you can bet that mild aches and pains were not covered, which is why I'm left with these crazy diagnoses like osteomas and leukemias. I was wondering if I could get a DDx from you guys and maybe some simple stretches or something that might help. Thanks for your help, sorry for the long post...

JPHazelton said:

Could be Tietze's

Pain your are describing is commong in active young adults who lift weights, play sports and run. Worse in females as the breast tissue tends to cause more stress to the myofascial structures in this area.

Osteopathic treatments could help and are pretty simple. If this isnt an option then just stretching the area would be advisable.

I doubt you are going to palpate anything more than a tender spot or possibly a small section of hypertonic muscle.

So stretch, ice for pain and ROM excersises and if you can find a doc to do OMT or similar, try it. Avoid over the head weightlifting...no military press. If you are currently doing bench press or flys you may want to back down on the weights.

I have a dozen or more patients with similar complaints. It is rarely the chief MSK problem but it can be an annoying one, especially for more active individuals. One patient was an active swimmer and the pain got so bad that he had to change his strokes...which put more strain on his shoulders. Some OMT and rest took care of it.

Dispensing medical advice around here is always a bad idea so here is my little disclaimer:

Dont do any of the above until you talk to your doctor.

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Thanks a bunch... I realize that internet medicine is next to useless, but its good to know that loads of people complain of this stuff. You tend to get isolated in a sea of disease during 2nd year and it has gotten hard for me to believe that anyone is healthy anymore...

DrB said:

I just treated my classmate with a similar Hx as you.

We figured it was due to her sleeping position as she slept on her side.

Her upper ribs on the right (3 and 4) were stuck in Exhalation (upon palpation the left side raised its pump handle motion easier than the right). I treated it with Muscle energy for the costal region indicated. After a very quick treatment (less than five minutes) she felt much better. We have learned a few Still techniques that may have also been helpful, but we ran out of time.

Flobber, check with your local Osteopathic Medical school...

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Closest osteo school is Michigan State and I hate the Spartans... hehe. Again, good to know someone else has these things. Thanks!