Chronic costochondritis with reproducible subluxation of ribs

[Doctodd]

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40ish white female s/p MVA a few months ago with reproducible pain in otherwise very good health, physically fit, owns a dive shop in the Keys. She can actually move or palpate her chest and reproduce the ligamentous laxity in her sternum causing an audible rub. First tried some usual injections with minimal results. Tried prolo to tighten the ligaments with ZERO benefit...pain was worse as it should be, but was hoping for some improvement after. None. Suggestions?

 

[lobelsteve]

If rib is truly subluxing, get Ortho to put a fascial graft and sew it down.

 

[Lizard1]

Funny - I have nearly same pt but her's started after a violent seizure whilst in the ER. Get this, here PCP had her on Xanax 2mg q3-4hrs and then he suddenly stopped it because he was being investigated by state board. Thankfully she was in ER when she had withdrawl seizure. Anyway, severe costchondritis that is reproducible. New PCP started her on Lortab 10 1-2 q4hrs prn pain - tells me she's taking up to 10 per day. States her Uncle is a "famous orthopedic surgeon" in Dallas and he says she's gonna have to deal with it - other option is to break her sternum(?). And naturally NSAIDs irritate her stomach. She tells me she just needs "her" Lortab to be able to pickup and care for her 3yr old.

My rec - requiring that much narcotic indicates surgery may be warranted. Here's enough for 1 to 2 per day until you can get an appt with your famous uncle.

 

[drf]

Chiropractors fix subluxing stuff all the time.