Is a Dis-articulated Thoracic Rib rare?

[Lvcien]

Hi Docs,

About me:
I'm in Pre-med with the end goal of going into anesthesiology then to interventional pain management and addiction medicine... I'm also a chronic pain patient since June 06 (long story, won't explain here) - I'm very interested in the issues severe chronic pain has on the brain and body as well as cutting edge/experimental treatments to stop pain.

In your pain management practice have you ever seen a full dis-articulated thoracic rib which is dis-articulated at the costovertebral joint and possibly the costotransverse joint that causes severe pain when breathing, twisting, bending, lifting, etc. - a real "medical" dis-articulation NOT a simple chiropractic subluxation.

It seems to be a rare condition - this was the second that the radiologist at my pain management center had ever seen.

Thanks,

Lvcien

Note: I'm not asking what methods of treatment could help this issue - I'm just trying to assess how common or uncommon this is. I don't believe this is violating TOS since I'm not solicting medical advice for treatment, etc. If it is somehow violating TOS - please PM me and I'll take care of the issue assuming the moderation team hasn't already.

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[lobelsteve]

Rare.

I have seen disarticulated ribs about once a year. They always are seen on plain films. Most cases like this that I have seen are mildy subluxed or lax capsules on CV joints. CV joints are usually replaced at 60,000 miles. Oh wait, that is constant velocity joints.

Pump and stim for this seems more like robbery than treatment. Unsure why/if MBB/RF of the segment above and at level of joint wasn't done/didn't work. IA injection helpful short term. PT can usually build the muscles over the area and tighten it up enough to relieve symptoms. I use topical NSAID's for most of these folks and rarely do any procedure. If anyone failed to get better with PT/MBB, I'd be looking at CT scan.

 

[Intubate]

Steve, this is off topic, but your topical NSAID comment reminded me-- is anyone using this stuff for lumbar or cervical facet pain, and is there a study underway? Seems like a good idea in theory.

 

[masterofmonkeys]

Personal experience, I've had good results from exercises which strengthened the axial musculature in the area, especially with front loading (front squats, overhead shrugs, front supports, zerchers) and topical NSAID. The PTs weren't a lot of help; I used a kinesiology text and a muscular anatomy book to figure out what to do myself.

I also personally get a lot of help out of topical NSAID with facet garbage up in the neck too.

200mg celebrex and 10mg meloxicam barely touched that though.

There's a voltaren cream formulation from India that also uses menthol (Volini), which I freaking love.

 

[Lvcien]

Thanks for the input - Lots of PT and muscle strengthening never worked - but an MBB/facet joint injection is the only thing that wasn't tried as my doc didn't think it would be effective since none of the other injections were.

Anyways, thanks for your input - so as not to violate TOS (again) - I'm not asking what else can be done 🙂

Thank you..