rib pain

Hi, a friend of mine asked me to have a look at his back as was experiencing very specific pain in R rib (rib 10). On ax back ROM fine, slight twinge on EOR rotation r and L. On palpation, pain very specific to a point about the size if my fingertip on the tenth rib about 3 inches from spine. Pain NOT increased by cough/sneeze/deep breathing. No POP of intercostal muscles. No recent hx of trauma, though previously had fallen onto this side and felt had perhaps # ribs then but did not seek rx, and had no scans. This was a couple of years ago. General health no problems, no red flags.
Am a bit lost. considering sending for a scan but just wanted to put it out there and see if anyone had any sugestions??
Thanks for any replies
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That pain is caused by a pinched muscle in your back.

thanks for your reply. Just wondering why is he getting pin point specific pain on palpation of bone?? I agree there may be a muscle spasm around the area for sure but i think this must be something other than a muscle??I could definately be wrong though :)

ahhhh help! anyone have any ideas?????

I think the pain may be coming from the hypomobility of the ribs.Try to mobilize the ribs.
I also had a patient with the same problem and I treated him with rib mobilization,he was fine after 2 sessions.

Hi - there are many potential sources of pain. In this case the specific spot you could be feeling could be a fascicle of one of the erector spinae muscles or a stress reaction in the bone.

The thorax is not well understood by most - i would suggest you try to do a course by discoverphysio.ca who run thorax courses developed by Linda Joy Lee and Diane Lee.

As for treatment, support the 10th rib during rotation and see if that helps. From there, you may have to release a muscle if it is overactive ormobilise a joint if it is stiff or retrain activity if it is a poor motor control issue.

Cheers

Hi Arthurart09 - why do you think so?

hey physioeims
want to tell you about this thing that you stand at the back of patient hold his pelvis firmly cuz ur actully going to stable it then ask the patient to slouch or protract along with lumbar flexion then tell the patient to rotate his spine at the side of pain and tell him to take deep breath hold for ten second,give him breathing exercise make sure u should hold him firmly so his hold at pelvis will remain firm ok try it best of luck

Hi,
try to palpate the lower border of the rib preferably in side lying, comparing to other ribs u can palpate the lower border of this particular rib, a bit more palpable which denotes that the rib is rotated, the approach mostly used is muscle energy technique.its just an idea, but try to corelate.

Thanks

The pain on rotation is seen very often in rib troubles. Have you tried rotating him from side to side and then force him to inhale maximally? This maneuver can sensitize the test a bit and hopefully point you in the right direction. The costotransveres and costovertebral joints also share innervation with overlying skin (medical/lateral branches of the dorsal ramus), thus sensitivity from a rib subluxation can also produce focal tenderness on the overlying area. As I'm sure you are aware the ribs are often affected by bony pathology a plain films are beneficial in ruling out anything more serious. I very successfully manipulate these types of rib lesions after a full work up has been completed. The procedure is very simple and uses a rolled towel placed over the lesion (bias the side which is problematic) have the patient interlace their hands on the back of their neck. You then with the towel pinned on your belly will reach around taking hold of their wrists. You will have very good control over their body in this position and so even If you aren't game you can still use this set up to mobilize the rib. have them relax into the towel and then deliver a HVLA thrust through your towel to the lesioned site by extending your legs and tractioning upwards. You will likley hear a pop and patients feel almost immediately better if this is the problem and you get it right! I would recommend reading and looking at some pictures in this book before you try or refer them to someone who has manual manipulative training (physio/osteo/chiro):
Spinal Adjusting Technique by Downie, Phillipson and Esposito.

Hi - thanks SPPAWA - the only thing i would like to add to the above is a caution when using the manipulation - don't over do it - i think the technique and other manipulations are good with accurately diagnosed problems and the joint is fixated but often people manipulate everything and don't ask why or how it got stuck in the first place...don't forget to retrain the motor control of that rib as often ribs that get fixated have an underlying hypermobility that allowed it to become fixated in the first place...cheers!