Inflamed nerve - elevated first rib - what to do?

[Lhollo]

I'm in a lot of pain and hope someone might be able to give me some pointers as to what to do. Sorry this is long - I didn't want to leave out anything important.

I have a long-term problem for which I've been seeing a physio. He's on holiday at the moment and it's flared up very badly, in a slightly new way which I don't know how to deal with.

I was first treated for whiplash and related postural issues. I then started having trouble with an elevated first rib, inflamed nerve, and pain spreading from my neck and shoulder down my arm to my hand and wrist. A lot of this comes from working at the computer, but I do have the best ergonomic set-up I could get.

I last saw my physio earlier this week and the problem was again the first rib, but also another point in the middle of my chest, about 3 or 4 inches down from my collarbone. I think it was something to do with more inflamed nerves and a twisted ribcage. The shoulder and arm trouble is on the left but my ribcage was up on the right of my back.

Apparently I'm hypermobile. Everything tends to move out of place too easily.

My shoulder now feels as though it's not sitting quite right, and as though it'll dislocate at the least thing. My upper chest feels tight. I can't sit or lie or move without a lot of pain and I can't sleep. Painkillers only begin to touch it.

I've been using a heat pack but don't know whether this could make it worse. Should I use ice instead?

I'm not on any medication and have no illnesses.

Are there any exercises that might help?

Should I finally go to the doctor about this?

Basically, any help would be very, very much appreciated.

Thanks for your time!

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[Judith Mollet]

It's not impossible that you have had some sort of reaction to physio you had this week, you said you had seen the physio earlier this week. Despite you trying to explain so many details it's difficult to say exactly online what is wrong as we can't assess you. Sounds like something has provoked an acute flair up of a chronic problem.
Did the physio warn you at all about any possible exacerbation of symptoms after the last treatment?? Did he say what could be expected? Does he have a locum or is he somewhere possible to contact on his mobile phone?
Warm pack may make symptoms worse if it's acute new pain. Trying cool or colder might well work. Or various hot /or cold stuff to apply like sport cremes etc. Anything working on your pain nerve endings in the skin can potentially stop pain for a while and give some relief, if only temporarily. (I'm not sure how big an area you are hurting in)
If it doesn't start to get better ie less pain very soon and your pain killers aren't helping at all, a different medication from your GP may help. Pain comes in various forms and the mechanisms for combating it are not always the same. If the symptoms are really so different to normal and it's worrying, do go to your doctor (preferably the one who knows your case history best)and ask or at least phone up. It may well be that he doesn't know any more than a physio who has been treating you for a while, but he could reassure you that it's nothing awfull if he sees you. I hope this is the case.

[Lhollo]

Thanks for your reply!

There's no way for me to contact my physio, although I could call his co-worker.

I don't think it can be a reaction to the last treatment, because I was better for a few days after it. I rested all week, as he'd told me to. Then, this weekend, I drove for 20 minutes to a meeting I couldn't avoid. Since then it's been hell.

The new aspect to it is the other rib/chest thing, which my physio did treat at my last session - that's how I know about it. It was the first time I'd had that problem - previously it's only been the first rib. He did seem quite concerned this time and really rammed home that I need to rest and not spend long hours at the computer.

I'm guessing that it's thoracic outlet syndrome, with another rib thrown in as well, and he's trying to halt its progress.

With it suddenly worsening this much, and him being away this week, I just don't know who to ask for advice as to what to do and what not to do. The only time I'm sure I'm not making it any worse is when I'm out walking. It's hard to rest when I can only sit bolt upright and even then it hurts, and I'm desperately trying to get used to sleeping on my back.

I'll lay off the heat pack for now and maybe try ice.

I'll also call my doctor in the morning.

Thanks again, and please do let me know if you have any other suggestions or advice.

[Judith Mollet]

Are you left handed? Just wondering about the pain distribution down the arm on the left side?
Has the physio looked at muscles like the scalenes that go from the transverse proccesses of the neck vertebrae to first and scond rib?
They can have trigger points in them that give your pain distribution symptoms.
Indications: back,shoulder and arm pain. Thoracic outlet sydrome. Scalene syndrom. Oedema in the hand. Whiplash. 'restless neck'. Irritability.
Referred pain patterns:
anterior: persistant aching, pectoralis region to the nipple
posterior: upper medial border of scapula
lateral: front and back of arm to the thumb and index finger
Differential Diagnosis: Brachial Plexus. Subclavian vessels. Cervical discs c5 c6. Thoracic outlet syndrom. Angina. Carpal tunnel. Upper trapezius. Sternocleidomastoid. Splenius capitis.
They can be activated by various things. Often pulling or lifting. Relief sometimes comes if you hunch shoulders towards ear or let underarm be supported on something under your ellbow when sitting to reduce the pulling downwards effect when they are aggravated. Having had a whiplash all sorts of factors can be involved. Driving could have stirred them up. Moist warmth but not hot hot hot around neck may help.
Gentle stretch of them like move ear /shoulder away from each other (on the same side ) can help as part of a treatment but diagnosis online is an iffy affair and I can't be sure if it is that or what your physio is doing with you.