Costochondritis | Rehab My Patient

Posted on 01st Jul 2018 /
Published in:
Ribs
,
Thoracic Spine

Costochondritis is when the cartilage connecting the breastbone and the rib becomes inflamed, the junction is referred to as the costosternal joint. Pain from this condition can mimic the signs of a heart attack and various other conditions relating to the heart. It can also mimic the signs of acid reflux and indigestion. Pains can also travel to the spine and between the shoulder blades. Some doctors refer to costochondritis as costosternal chondrodynia, chest pain or costosternal syndrome, or Tietze’s syndrome.

Most of the time, those who have costochondritis don’t have an attributed cause to their condition, although research tells us that poor posture is often to blame. Occasionally it can be caused by trauma.

Costochondritis Anatomy

The chest consists of the portion of the trunk located between the abdomen and the neck. It holds the lungs and the heart, as well as that of the esophagus and the large blood vessels connecting the heart. Inside of the chest wall, you will find cartilage, bones, ligaments and muscles holding all of the chest contents together. The rib cage consists of the ribs, sternum and the vertebrae. The ribs are connected
with the vertebrae in the back and to the sternum in the front. Ribs, joints between all of the vertebrae and the sternum let the bones move freely. Soft tissues, such as the muscles, ligaments and nerves, make up the chest wall.

Symptoms:

• Pain over the sternum and upper chest
• Usually worse after exercise
• Worse taking a deep breath in
• Inflammation (redness, swelling over the area)
• Pain may be referred to the arms or shoulder

It is important for the physician to exclude more serious pathology e.g. heart or cardiovascular problems as costochondritis may feel like a heart attack. It is also not unusual to be investigated for reflux or digestive problems, which can mimic the signs of costochondritis.

• Symptoms should ease in 4-8 weeks
• All symptoms should disappear in 6 months
• Having the condition once does not increase your chances of having the condition again

How to Treat Costochondritis:

1. Stretching Exercises
   Undergoing gently, range-of-motion exercises has proven to be helpful in overcoming this condition.
2. Nerve Stimulation
   This procedure is known as TENS, which is a device that sends a small electrical current by patches on the surface of the skin close to the area in pain. This can mask or interrupt pain signals, which will prevent them from ever getting to your brain in the first place.
3. Physical Therapy
   Manual and physical therapists are brilliant at improving posture, improving mobility to your ribs and spine, and reducing the muscle tension that pulls on the ribs.
4. Medication
   You doctor may prescribe you anti-inflammatories, painkillers to reduce the pain and inflammation. Low dosage anti-depressants such as Amitriptyline is often used to control chronic pain, especially for those who are struggling to sleep at night.
5. Cold Application
   It is widely agreed that costochondritis is an inflammatory condition. So one of the best ways to treat it is with an ice pack or frozen peas. Place them over your chest, where your pain is located, wrapped in a tea towel for 5-10 minutes three times per day. This is effective in reducing the pain and inflammation. You may need to continue this for several weeks.

Tips:

• Women and those over the age of 40 are most prone to costochondritis.
• Encourage children to use their school bags correctly. The bag shouldn’t be too heavy or else their shoulders will slump. Show them how to carry the bag the right way.
• Avoid any activities that trigger the pain. If tenderness and chest pain result from physical exertion, ask about safe guidelines for lifting and an exercise program.
• Severe coughing and other strenuous activities are attributed to costochondritis.
• Maintain good posture at work. Keep upright. Ensure your computer work station is set up correctly with the monitor at the correct height. All too often costochondritis is caused by poor posture.
• Avoid stress as much as possible. Take steps to relax regularly through the week. Try deep breathing exercises, watching a good movie, or reading a book to de-stress.
• You should make a gradual return to exercise, using slow stretching to avoid re-injury.

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Costochondritis | Physio Check

Costochondritis is a painful inflammation of the cartilage of the ribs. This cartilage is located along the front of the chest where the ribs connect to the sternum, but also along the back, where the ribs attach to the spinal column.

Costochondritis is a relatively unknown rheumatic condition. As the condition often causes pain on the chest, it is always important to rule out cardiac problems before making the diagnosis.

Description of the condition

The chest (rib cage) is formed by the ribs, the breastbone and a number of vertebrae. Along the front, the ribs are connected to the breastbone by cartilage structures. These cartilage connections are referred to in medical terms as ‘costal cartilage’. If this cartilage becomes inflamed, this is referred to as costochondritis. Inflammation of the ‘costal cartilage ‘ causes annoying pain on the chest.

Along the back, the ribs are connected to the vertebrae of the spinal column via small joints (also containing a layer of cartilage). These joints are called the ‘costovertebral’ and the ‘costotransverse’ joints. Again, if the cartilage becomes inflamed, this is referred to as costochondritis. Costochondritis along the back can cause back pain in the upper back.

Tietze’s Syndrome
Costochondritis is very similar to Tietze’s syndrome. However, there are a few important differences. When the cartilage of the ribs along the front of the body is inflamed and is accompanied by swelling, this is referred to as Tietze’s syndrome. If there is no swelling, or if the cartilage along the back side of the ribs is inflamed, this is referred to as costochondritis. Unfortunately, both terms are often used interchangeably in the literature.

Cause and origin

The cause is currently unknown. However, we suspect that the following factors play a role in the development of the conditions:

• Physical exertion.
• Incorrect posture (for example, a stooped posture with rounded back and shoulders protruding forwards).
• Over-loading or trauma (for example, falling or bumping the chest).
• Pregnancy.
• Respiratory tract infection.
• Emotional exertion/tension.
• Stress.
• Repetitive movements that expand the chest, causing pressure or tractive force on the ribs (for example, deep breaths, lots of coughing or repeated clearing of the throat).

People with a family history of rheumatic conditions have an increased risk of developing the condition. Postural abnormalities, limited muscle strength, fear of movement and a low exercise tolerance are also linked to an increased risk of developing costochondritis.

Signs & symptoms

Several cartilage connections are usually affected in the case of costochondritis. In many cases it affects the second to fifth rib. It is worth noting that generally only one side is affected.

• Pain on the chest and/or pain in the upper back at the level of the cartilage connections.
• The pain is often sharp and comes in waves.
• Pressing on the inflamed cartilage makes the pain worse.
• Coughing, sneezing or deep inhalation is extra painful.
• The pain can radiate to the ribs, the arm, the shoulder or the abdomen.
• Movements of the upper body cause extra pressure or tractive force on the cartilage connections. This can result in extra pain.
• As the entire rib cage moves along with the various arm movements, certain movements of the arm can provoke the symptoms.

Diagnosis

The diagnosis is made according to the physical examination and the patient’s story.

Treatment

Unfortunately there is no real treatment. Patients are often prescribed analgesics to relieve the pain, or anti-inflammatories. Sometimes injections are administered at the site of the inflammation.

In some cases the symptoms disappear without treatment within several days or weeks. However, the condition can become chronic, causing problems for months or years. Sometimes the symptoms never go away completely.

Physiotherapy can be used to work on improved posture, thereby reducing the pressure on the painful cartilage connections. Therapy can also consist of the stretching of the pectoralis major muscle and strengthening of the rhomboid muscles located between the shoulder blades. If necessary, relaxation exercises and breathing exercises will be provided.

Advice

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References

Albarran, J.W. & Tagney, J. (2007). Chest Pain. Advanced assessment and management skills. Blackwell Publishing.
Haga, P., Biesen-’t Riet, J. van der & Broekema, A. (2008). Protocol syndroom van Tietze en costochondritis. Oefentherapeuten Mensendieck.
Lawless, C.E. (2011). Sports cardiology essentials: Evaluation, management and case studies. Springer: New York, Dordrecht, Heidelberg, London.
Proulx, A.M. & Zyrd, T.W. (2009). Costochondritis: Diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.

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Costochondritis Royal Oak, MI | Van Every Family Chiropractic Center

Costochondritis is an inflammation of the connections where the upper ribs join with the cartilage that holds them to the breastbone or sternum. The condition causes localized chest pain. Though it’s relatively harmless, costochondritis can be bothersome and painful. The cause is often unknown but may occur from increased activity involving the arms.

What Does It Feel Like?

The number-one thing we hear at the practice is it feels like someone is taking an ice pick to your back. People with costochondritis also feel a sharp pain, particularly when they’re breathing. Men with the condition often head to the hospital as they think they’re having a heart attack.

Ruling Out Heart Disease

Adults who complain of chest pain may be diagnosed with costochondritis. Chest pain in adults is considered a potentially serious indication of a problem with the heart by the majority of doctors until proven it’s not. Adults with chest pain will typically be given an array of tests to rule out a heart attack and heart disease.

Any adult with chest pain should be examined and tested for heart disease before a diagnosis of costochondritis can be made. It is often challenging to distinguish between the two without further testing.

If all of the tests are normal and your physical exam is consistent with costochondritis, your doctor will inform you that the condition is the cause of your chest pain.

Who Is Affected by Costochondritis?

People of all ages can experience costochondritis. The condition (with unknown cause) is a common cause of chest pain in children and adolescents. Costochondritis accounts for 10% to 30% of all chest pain in kids. Both women and men can suffer from the condition. It affects females more than males (70% versus 30%).

What Are Some Causes?

• Coughing
• Exercise
• Pregnancy
• Sneezing

Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.

How Does Chiropractic Help?

If your ribs are out of position, we use gentle KST adjustments from the front and the back. Adjusting the sternum helps as does adjusting the muscles around the rib cage. The tool we use gently taps the ribs into the correct position. An attachment also can be used that glides over the ribcage to address both the front and back of the ribcage.

The goal of chiropractic in addressing costochondritis is to allow your ribs to move and glide easily, especially when you’re breathing.

We also may recommend using heat or ice to help alleviate discomfort.

Book an Appointment

If you think you’re experiencing costochondritis, contact us today to schedule an appointment!

CONTACT US TODAY »

Costochondritis in Royal Oak and Clawson MI | (248) 616-0900

Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated

Objectives:

Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain.

Method:

An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics.

Results:

Average age of the study group was 53. 4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases.

Conclusions:

Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

Shoulder Arthritis in Pensacola & Gulf Breeze FL

The medical definition of arthritis means inflammation of a joint. It can be used to describe any process that results in cartilage loss. When the cartilage in the shoulder joint wears away or is damaged, the resulting arthritis often becomes symptomatic.

Because the smooth cartilage that envelopes the surfaces of the ball (humeral head) and socket (glenoid) is reduced or completely worn away in shoulder arthritis, there is bone-on-bone contact that occurs during certain motions. Over time this results in increasing stiffness, pain, swelling, and limited use of the shoulder. It may also mean that the patient may have difficulty participating in sports, working a physically demanding job, sleeping, and eventually even engaging in daily living activities becomes painful.

Types of Shoulder Arthritis

There are five main types of arthritis, including:

A progressive degenerative disease, osteoarthritis is by far the most common type of arthritis that becomes more common with age.

The immune systems of people who have rheumatoid arthritis attacks healthy joints, tissues and organs. There are usually multiple joints involved. This type of arthritis most commonly afflicts people between 15 and 44.

This type of osteoarthritis develops after an injury to the shoulder, such as a fracture or a dislocation, and can occur after shoulder surgery, sometimes many years later.

Causes and Risk Factors

Once thought of as a ‘wear and tear’ phenomenon, the actual cause of osteoarthritis is unknown;. However, several factors that contribute to the condition have been identified, including:

• Prior shoulder surgery
• History of trauma
• Inflammatory conditions (usually associated with Rheumatoid arthritis)
• Overuse of the shoulder

Those who are at greatest risk for developing shoulder arthritis are those who partake in high intensity overhead activities, such as:

• Weightlifters
• Tennis players
• Racquet sport players
• Basketball players

Diagnosis

In order to diagnose shoulder arthritis, your doctor will take an initial medical history and perform a physical examination. During the physical examination, your doctor will be looking for the following:

• Muscle atrophy
• Tenderness in the shoulder
• The extent of passive and active range of motion
• Signs of injury to the muscles, tendons and ligaments that surround the shoulder
• A grating sensation upon movement of the shoulder
• Pain when pressure is applied to the joint
• Involvement in other joints
• A history of when, and during what activities the shoulder hurts

Your doctor will also perform one or several of the following imaging exams:

• An X-ray
• A computed tomography (CT) scan
• A magnetic resonance imaging (MRI) scan

Treatments and Procedures

Presently, there isn’t a cure for arthritis. There are, however, many treatment options to help individuals manage their shoulder arthritis pain and stay active. In order to assist with the pain and the inflammation, your doctor may prescribe anti-inflammatory medicine.

Other forms of treatment for arthritis of the shoulder include:

• Occupational therapy
• Physical therapy (which involves the use of exercises and other treatments to reduce pain and inflammation, and improve range of motion)

In the most extreme cases, surgery may be recommended. The type of surgery that your orthopaedic surgeon will recommend depends on four primary factors, including:

• The severity of the pain caused by the arthritis
• Age
• Activity level
• The condition of the rotator cuff

In patients who have severe arthritis, joint replacement is generally an extremely effective surgery and typically renders excellent results. Shoulder arthroplasty involves the replacement of the damaged joint.

There are different forms of arthroplasty, including:

• Total arthroplasty – both the head and the humerus and the glenoid will be replaced.
• Hemiarthroplasty – only the head of the humerus is replaced with an artificial component.
• Reverse total shoulder arthroplasty – a metal ball is affixed to the glenoid and a specialized socket is affixed to the upper end of the humerus.

Since the stiffness, pain, limited range of motion with shoulder arthritis can worsen over time, it is important to see a physician or orthopaedic surgeon early.

Frequently Asked Questions

Can shoulder arthritis cause neck or chest pain?

If you have rheumatoid arthritis, you may experience pain in your neck and chest as a result of your arthritis. When chest pain occurs as a result of rheumatoid arthritis, it is called costochondritis, a condition that is often mistaken for a heart attack. This pain is often a sharp, stabbing pain experienced in a small area near the center of your chest; a heart attack usually radiates to other areas of your body and is often accompanied by lightheadedness and sweating. It is always best to err on the side of caution and consult your physician if you are experiencing chest pain to rule out the potential of a heart attack.

Is there a CURE for shoulder arthritis?

There is currently no cure for shoulder arthritis. There are, however, many highly effective treatments to help you manage your shoulder pain without being sidelined from your favorite activities – whether they are weekend sports, gardening, or professional pursuits.

Ways to ease shoulder arthritis pain?

Your doctor may prescribe anti-inflammatory medications to ease the pain and inflammation associated with your shoulder arthritis. Other treatment options include things like chiropractic treatments, physical therapy, occupational therapy, exercising, rest, corticosteroid injections, heat and/or ice therapy.

If your arthritis is severe, you may consider consulting your orthopaedic surgeon about the possibility of shoulder arthroplasty. The earlier you schedule an appointment with your orthopaedic surgeon, the better your results are likely to be.

What does shoulder arthritis feel like?

Initially, shoulder arthritis symptoms include things like stiffness in your shoulder, pain at night, and difficulty using your shoulder for lateral and overhead movements. Some patients describe it as feeling a deep ache in the affected shoulder. You may experience some pain that is severe enough to disrupt sleep. Your shoulder pain may worsen upon activity and with changes in weather.

As the condition progresses, you may experience pain that radiates to other areas, especially your arm and occasionally your neck or chest. The pain and stiffness of your arthritis may come and go over time and may be exacerbated by weather changes.

Who can help me treat shoulder arthritis?

Your physician may be able to treat initial stages, though if you have severe shoulder arthritis or your condition is deteriorating rapidly, you may want to schedule an appointment with your orthopaedic surgeon at O’Grady Orthopaedics. Dr. O’Grady and his staff use cutting-edge technology in all aspects of treatment, so they can offer minimally invasive procedures and expert care to help you find relief from your shoulder arthritis pain.

Infographic Resource:

Slipping rib syndrome – Caring Medical Florida

Ross Hauser, MD

Doctors recognize that slipping rib syndrome is often unrecognized at the time of patient diagnosis and therefore an overlooked cause of chronic pain in the abdominal and/or chest pain area.

Doctors also recognize that misdiagnosis or simply missing slipping rib syndrome as the cause of pain, the misdiagnosis may lead to excessive imaging, laboratory, and other complicated workups.

• Slipping rib syndrome, which is also diagnosed as Tietze’s Syndrome, rib subluxation, costal margin syndrome, painful rib syndrome, costochondritis, clicking rib, displaced ribs, painful rib syndrome, traumatic intercostal neuritis, clicking rib, or rib tip syndrome, occurs when one of the ribs intermittently slips out of place, causing a stretching of the ligaments that support the front and back of the rib.
  • Slipping rib syndrome can occur where the rib attaches to the thoracic spine (thoraco-rib instability) or anteriorly at the rib-cartilage margin (chondro-rib instability) or sternum-rib margin (sterno-rib instability). When it is the latter, that is when it is called costochondritis or Tietze Syndrome.
  • It commonly occurs in one of the upper ribs, because ribs one, two, and three take the bulk of the force when a person is bent over reading or doing computer work. When this condition affects the upper ribs, base of neck pain is common and can be severe, even causing pain down the arm into the hands and fingers, especially the index and little fingers.
  • The eighth, ninth, and tenth are also common culprits because unlike ribs one through seven, which attach to the sternum, the eighth, ninth, and tenth ribs are attached anteriorly to each other by loose, fibrous tissue. Although this arrangement provides increased mobility of the lower rib cage, it also results in a greater susceptibility to trauma in this area. When the condition affects the lower ribs, such as the eighth, ninth, tenth, chest and upper abdominal ribs, pain occurs from the recurring subluxation (dislocation) of the costal margins of the eighth, ninth and tenth ribs due to hypermobility of their anterior edges. This allows a rib to slip behind the rib above it.

Symptoms of Slipping Rib Syndrome

• Clinically, patients often note sharp, intermittent, stabbing pain followed by  a  dull achy sensation for hours or days. “Slipping:” and “popping” sensations are common, and activities such as bending, coughing, deep breathing, lifting, reaching, rising from a chair, stretching, and turning in bed often exacerbate symptoms.

Slipping Rib Syndrome Pain Causes

• The cartilaginous ends of these ribs come in close contact to the terminal branches of the intercostal nerves. These nerves are particularly vulnerable to even trivial trauma. The pain can be both excruciating and spontaneous, and it can even simulate a heart attack.
• Pain from a slipping rib can travel along the intercostal nerve root and go from the chest to the thoracic area or vice versa. It can also be felt in the abdomen, shoulder or neck. It may also be precipitated by lying or turning over in bed, sitting in a car seat or armchair, bending forward, breathing deeply, coughing, vomiting, walking, abducting the arm on the affected side, eating, rotating the torso, bending the trunk, or riding in a bouncing automobile.

Rib Instability and Hypermobility

Much of the research surrounds the pediatric and young athlete treatment of slipping rib syndrome as this uncommon disorder is more common in those two groups. However, adults can also acquire slipping rib syndrome with a forcible activity to the rib area including simple coughing to chest surgery for an unrelated cause.

• Rib joint instabilities can occur any time there is a violent force on the chest cavity, such as during athletic contact or even a thoracotomy (chest surgery). Rib joint instabilities can also occur when less force occurs over a long period of time, such as when a person has a low-level cough (bronchitis) or poor posture while hunched over a cell phone.
• Rib hypermobility is caused by weakness of the rib- sternum (sternocostal), rib-cartilage (costochondral), and/ or rib-vertebral (costovertebral/costotransverse) ligaments, allowing the rib to be hypermobile, and it is thought to be the primary cause of slipping rib syndrome. When this occurs, the condition causes chest pain in addition to upper back pain. Without large muscles to hold the ribs in place, loose ligaments allow slipping of the rib, which causes further stretching of the ligament and results in severe pain. A simple coughing attack due to a cold may cause the development of slipping rib syndrome. Conditions such as bronchitis, emphysema, allergies and asthma cause additional stress to the sternocostal and costochondral junctions. Even sinusitis, with its associated nose blowing, can be the initial event that leads to chronic chest pain from slipping rib syndrome.

Pain with deep breathing during strenuous activity and sport

One clue that the painful conditions are due to rib joint instability is when the pain is increased with deep breathing. The thoracic cage moves up and down to allow breathing, so all the structures of the thoracic cage, including the thoracic-rib-sternal articulations, are never truly at rest.

During inspiration, the upper ribs are elevated, which increases the anterior-posterior diameter of the thorax. The opposite occurs in expiration. When a healthy individual is at rest, the diaphragm and the intercostal muscles produce inspiration. The act of expiration is primarily passive. The action of the abdominals and the accessory muscles of the trunk and lower neck is usually minimal. However, when there are injuries or more serious oxygen demands, more of the respiratory muscles including the rectus abdominis is called into action as would occur during sporting activities, exercising or trauma. This puts a greater force on the rib attachments, and when instability is present symptoms increase.

Surgical options and non-surgical options

Surgery to remove a piece of a rib or the costal cartilage, the unique cartilage found only at the ends of the ribs may be recommended if either structure is protruding. Even surgeons consider these options “aggressive.”(1)

Non-surgical treatments may include recommendations for chiropractic manipulation, cortisone or nerve block. Typically these treatments have not found great success.

Prolotherapy for Slipping Rib Syndrome and rib attachments

Prolotherapy is an injection technique that stimulates ligament and cartilage repair. Prolotherapy will strengthen the weakened ligament junctions that can cause slipping rib syndrome – the sternocostal, the costochondral or the costovertebral junctions (the places the ribs meet to form the rib cage). It will also strengthen the costal cartilage.

Doctors writing in the Journal of Back and musculoskeletal rehabilitation published research that showed positive results for Prolotherapy.

• The doctors examined twenty-one patients who underwent Prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2).
• A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before and after injection first day, first week and fourth week.
• Group 2 received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times and clinical effects were compared between the two groups.

The Prolotherapy group showed a faster recovery, including significantly reduced clinic findings.

The doctors concluded that Prolotherapy could be performed safely and is a method with favorable long term treatments for Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and adverse events especially for those with limited liver and kidney reserve or significant comorbidities.(2)

A Caring Medical case history

The patient is a 35 year-old female. She had been rushed to the hospital for the fourth time in less than a year complaining of severe chest pain. Obvious concerns were with a cardiac event. After EKGs, blood tests, x-rays, and a stay in the intensive care unit, the cause of her pain was still unknown. Everyone began to wonder if she suffered from problems of mental illness and catastrophizing thoughts.

Upon her visit to us here at Caring Medical, she explained that she was not currently having severe chest pain but did feel a dull ache in her chest. She needed one more diagnostic test, physical examination with palpitation of the chest area to determine if the pain was being caused by problems related to Slipping Rib Syndrome.

In this patient’s case, the diagnosis was made very quickly. Pressure to the left fourth thoracic rib attachment onto the sternum and the patient’s severe crushing chest pain immediately returned. Had she ever been examined in this fashion? She said she had not. The patient’s pain was caused by slipping rib syndrome.

An extremely important point illustrated by this case is that even if an x-ray, blood sample, or EKG do not reveal a cause, they do not eliminate the presence of a physical condition as the source of chest pain. It is much more likely that the chronic chest pain is due to weakened soft tissue, such as a ligament or tendon. If heart and lung tests prove normal, yet the patient claims to still be experiencing pain, the patient is often given a psychiatric diagnosis.

Depression, anxiety, and other mental illness challenges are not the etiological bases for most chronic pain. They can be associated factors involved in the problem, but they are normally not the cause.  Chronic pain should be assumed to be originating from a weakened soft tissue.

In this case, a rib was slipping out of place because the ligaments that hold the ribs to the sternum, the sternocostal ligaments, were weak. Without muscles to hold the ribs in place, loose ligaments allow slipping of the rib which causes further stretching of the ligament, manifesting itself by producing severe pain. The loose ribs can also pinch intercostal nerves, sending excruciating pains around the chest into the back. Sternocostal and costochondral ligaments refer pain from the front of the chest to the mid back. Likewise, costovertebral ligament sprains refer pain from the back of the rib segment to the sternum where the rib attaches.

1 González Temprano N, Ayuso González L, Hernández Martín S, Molina Caballero AY, Pisón Chacón J, Martínez Bermejo MA. Slipping rib syndrome. An aggressive but effective treatment. An Sist Sanit Navar. 2015 May-Aug;38(2):329-32.

2 Şentürk E, Şahin E, Serter S. Prolotherapy: An effective therapy for Tietze syndrome. J Back Musculoskelet Rehabil. 2017 May 5.

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90,000 Pain in the shoulder joint. Diagnostics. Treatment.

Don’t be late, timing is of the essence!

Long-term pain in the shoulder significantly spoils the quality of your life, moreover, if it is not cured in time, it threatens the health of the shoulder in the future, so you need to seek the help of an experienced orthopedic traumatologist in order to identify and eliminate the cause of the pain in time.

The causes of pain in the shoulder joint and the methods of its treatment are explained by the traumatologist-orthopedist of Medicīnas center ARS Dr.Janis DOBELNIEKS.

Worried about the shoulder

The shoulder is a complex biomechanism. The shoulder joint is the only one in the human body that performs full rotation due to its anatomical structures. As soon as something is disturbed in this mechanism, even due to a minor injury, the shoulder does not work normally. If it was not a serious injury, then it is difficult to immediately determine the causes of pain, but pain always has a provoking factor that can cause long-term pain and complications in the future.

Don’t adjust to pain

Unfortunately, often the pain does not decrease, it becomes more pronounced and interferes with sleep at night. Many people try to adapt to the situation, and if because of the pain they cannot raise their hand, then they simply try not to do it. This causes the shoulder to become tighter, and over time, extensive joint damage and other problems develop, which can result in shoulder prosthetics and disability. Self-medication with pain relievers, ointments and compresses can reduce inflammation and pain, but anatomical damage to the structure cannot be repaired.If the shoulder hurts for a long time and does not go away, then you need to go to the doctor. It is important to understand that timing is of the essence when treating shoulder pain.

• If your shoulder suddenly begins to hurt, should start expectant tactics, reduce the load and allow the shoulder to rest. If the pain does not go away within two weeks and intensifies, this is a signal that the shoulder is seriously injured.
• In order not to waste time on unnecessary examinations , it is recommended to visit an orthopedic traumatologist to conduct a detailed examination of the shoulder joint and begin qualified and professional treatment.

Why does your shoulder hurt?

First you need to find out what exactly is causing your shoulder pain. Often the cause of pain is not revealed in the shoulder joint itself, but in the cervical spine, where the intervertebral discs, pinching the nerve roots, cause pain in the shoulder. It spreads along the nerve, all the way down to the fingertips. If there is a feeling of numbness and pain does not depend on the load, then it is recommended to consult a neurologist.

If the cause of pain in the shoulder joint itself is caused by damage to anatomical structures or inflammation , then it never spreads below the middle third of the forearm.The painful area can be covered with the palm of your hand. One of the common causes of shoulder pain is 90,021 partial damage to the tendon of the long head of the biceps – tear , which is often the case in athletes and physically active people. A tendon can be damaged or ruptured for no particular reason, as over time it wears out and loses its elasticity. This injury is characterized by pain when performing certain movements, even without the application of force. Sports activities are often limited – volleyball, swimming, golf.The second most common cause of shoulder pain is Rotator cuff damage . The rotator cuff is the union of many muscle tendons that move the arm in the shoulder. If it is damaged, the main complaint is pain, which is expressed not only when the hand is loaded, but also at night. The tendon can be completely torn from the bone or partially torn, the function of the hand seems to be preserved, but there are certain movements that cannot be performed. The cause can be both trauma and gradual damage to the tendon.Without moving the arm, the pain gradually decreases, but by resuming the movement, the shoulder may hurt again. The third most common cause of shoulder pain is deformity at the junction of the clavicle and scapula . Often there are processes on the bone – osteophytes, which press on the muscles, creating inflammation in the surrounding tissues and pain.

In six months it may be late . At the very beginning, the damaged tendon can be sutured, and the hand can fully function. Delaying time only does harm – after 6 months, cicatricial, adipose tissue grows into the muscle and causes muscle atrophy.These are irreversible changes that cannot be corrected during the operation, since the tendon can no longer be pulled down to the place where it was previously attached. After a year, it is almost impossible to perform a skilled operation with predictable restoration of hand function.

A feeling of instability in the hand is usually the result of various injuries that are caused by improperly performed, rushing, falling, etc. Not only during sports activity, but also in everyday life, there may be a feeling that the shoulder, as it were, jumps out of its place and hurts.Around the flat surface of the joint there is a cartilaginous lip, like the edge of a plate. If one edge of the plate is knocked off, then the head of the shoulder has a tendency to slip out and create pain. This is called a bankart injury, which is often combined with injury to the tendon of the shoulder, causing shoulder instability, pain, limited mobility, daily restlessness when performing a movement, etc. To preserve the quality of life, surgery is required, and otherwise the consequences can be very serious.The more often the head of the shoulder is displaced from its place, the more the joint capsule is damaged, the stronger the pain, the more limited mobility. Over time, arthrosis and irreversible damage to the cartilage develop, when a conventional operation will no longer help, since it is necessary to restore bone structures.

Diagnostics of the shoulder joint

Radiologist-diagnostician, Associate Professor, Dr. med. MAYA RADZINA

Various methods can be used to examine the shoulder joint. The most informative for the determination of traumatic bone injury is X-ray.Ultrasonography (US) is the first and foremost method for detecting soft tissue injury, which is the only method that examines the shoulder joint in motion to ensure that the tendon is not damaged after injury, or that the limitation of mobility is caused by soft tissue swelling or damage. The quality of an ultrasound scan depends both on the specialist and on the ultrasound machine itself. For the patient, this is a quick, affordable and acceptable examination.

If an ultrasound scan reveals damage, for example, to an element of the rotator cuff, then a magnetic resonance imaging (MRI) examination of the joint follows to assess damage to deeply located tendons and cartilage.MRI shows an anatomical image of the shoulder joint, the exact distance to a specific structure. This helps the orthopedic traumatologist to accurately plan the course and scope of the operation and to perform the treatment better. The faster you visit a doctor, the easier it is to diagnose the problem, the less the risk of complications in the future.

Arthroscopic surgery

Most often, the shoulder joint is operated with an arthroscopic method. 3-6 small incisions with a length of 4-5 mm are made. Through them, a miniature camera is inserted into the shoulder joint, which is connected to a computer, and instruments with which in one go it is possible to assess and eliminate all joint damage, restore damaged ligaments and muscle tendons, and cleanse compacted tissues and salt deposits.The traumatologist monitors the progress of the operation on the monitor screen with multiple magnification. This method has significant advantages: it is low-traumatic and gentle, the incision sites heal quickly. New technologies make it possible to qualitatively and accurately assess the condition of the joint, even in places where it is impossible during a conventional surgical operation. The operation lasts up to 1.5 hours – it depends on the volume and complexity of the damage. It is performed on an outpatient basis at the ARS Day Hospital under general anesthesia.The patient can return home the next morning. The arm is freely suspended in a gusset band that protects against accidental movements.

Gentle rehabilitation

For the shoulder to be at rest, it takes 4-6 weeks to wear a scarf for the arm. Then, under the supervision of a physiotherapist, therapeutic exercises begin. Rehabilitation lasts about 3 months, pain after surgery can last up to 3-4 months. It will take 5-6 months to fully regain its shape.The hand should be especially taken care of during this period. It is better to save your hand for 2 months than not to move your whole life.

Medical center ARS
Skolas iela 5, Riga
Tel. (+371) 67 201 007
www.ars-med.lv

90,000 Shoulder pain on movement

Excessive stress on the arm, the need to lift or carry a heavy load sometimes leads to consequences in the form of pain in the shoulder. Hypothermia, intense training, unsuccessful arm movement – can also cause such pain.Such pains are understandable, they are usually tolerable and go away after a while with or without treatment. But when the pain in the shoulder becomes constant or appears at a certain position of the hand, accompanied by pain in other parts of the body, numbness, and other complaints, you should consult a doctor.

The most obvious reasons that can cause shoulder pain are diseases of the spine and shoulder joint, which is under heavy and complex stress. With osteochondrosis of the cervical spine and a herniated disc, the roots of the spinal nerves can be squeezed, the pain radiates to the shoulder, and can also be given to the arm.Inflammation of the tendons surrounding the shoulder joint, bursitis, damage to the muscles of the shoulder, deposition of salts in the tendons lead to pain in the shoulder joint. Shoulder trauma, periarthrosis of the shoulder scapula, inflammatory diseases of the shoulder joint are also causes of shoulder pain.

But sometimes shoulder pain is not related to the spine or the shoulder joint. The simplest example is angina pectoris or myocardial infarction, in which pain often radiates to the left shoulder. Diseases of the liver, pneumonia, tumors of the chest organs are also often manifested by pain in the shoulder at the initial stage.The accompanying symptoms will show that this is not a habitual stretching or hypothermia of the muscles. Without qualified medical assistance, it is not possible to determine the cause of such pain; a thorough medical examination may be required.

The specialists of the Eleos clinic are ready to assist you in diagnosing and treating the causes of shoulder pain. A neurologist, traumatologist, therapist, cardiologist will help determine the causes of pain and prescribe treatment. Specialists in physiotherapy, massage, exercise therapy, non-traditional methods of treatment will provide a full course of therapy and rehabilitation to restore working capacity and return to the usual rhythm of life.

90,000 Shoulder Pain – Spine Rehabilitation Center

Shoulder Pain – Spine Rehabilitation Center

General symptoms

Surprisingly, the shoulder joint can withstand almost 70% of the entire load on the body. Because of this, the shoulder girdle is prone to pathological changes. In addition, due to its complex structure, shoulder injuries are often diagnosed. The main danger that lies in wait for a person suffering from prolonged pain in the shoulder joint is a complete loss of working capacity. The inability to raise a hand or any object leads to disability.To avoid such a development of events, , if pain occurs, contact the clinic of vertebrology of Dr. Oleg Savyak .

Why shoulder hurts

The causes of increasing discomfort can be divided into several groups: orthopedic pathologies, injuries and diseases provoked by external factors:

• arthritis – inflammation;
• arthrosis – destruction of cartilage;
• tendonitis – tendon inflammation;
• Herniated disc ;
• scoliosis, kyphosis, lordosis – curvature of the spine;
• spondylitis – an inflammatory process in the vertebrae;
• osteoporosis – calcium leaching from bones;
• intercostal neuralgia;
• cervical osteochondrosis;
• dislocations and fractures , including untreated injuries;
• joint hypermobility syndrome – increased mobility;
• heavy or repetitive physical activity;
• sedentary .

These are the most common causes, but not all factors that can cause shoulder pain. First of all, make sure that there is no infectious infection and cardiovascular defect – myocardial infarction or angina pectoris.

Treatment in the Savyaka clinic

After a thorough diagnosis, if a disease of the musculoskeletal system is detected, the doctors of our clinic will develop an individual treatment regimen. Depending on the severity of the symptoms, the type of disease and its neglect, you may be prescribed spinal traction using different methods, manual therapy, arthrotherapy, massage, exercise therapy, physiotherapy and taking herbal remedies .All methods are safe and painless, have proven their effectiveness over decades of practice.

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Shoulder-scapular periarthrosis | Spine Treatment Clinic “Vertebrocenter”

Pain and limitation of movements in the shoulder joint are a frequent companion of a person.It is difficult to wash, it is difficult to comb your hair, it is difficult to work with your hand – all this forces a person to consult a doctor, where the doctor, with a 99% probability, diagnoses humeral-scapular periarthrosis. And to what extent does this diagnosis reflect the essence of the disease? Let’s figure it out together.

The shoulder joint is the most mobile joint in the human body. Pain and limitation of movement in it immediately affect the quality of life.
Most often, pain occurs after any load on the arm, injuries, falls, but sometimes pain can occur on its own, without precursors.

What is the cause of the pain?

The so-called humeral-scapular periarthrosis is a collective concept, the diagnosis “trash heap”, which does not reflect the essence of the disease, from this diagnosis it is not at all clear what exactly hurts, where is the damage?

Arthrosis of the shoulder joint is an extremely rare disease. Why? Because there is no axial load on the shoulder joint, there is no resistance to the attraction of the earth (as in the knee, hip joints and spine joints) – we do not walk on our hands (with rare exceptions) – as a result, the effect on the hyaline cartilage in the shoulder joint is several times less.therefore, arthrosis of the shoulder joint is extremely rare.

The main cause of pain in the shoulder joint is damage to the musculo-ligamentous apparatus. Yes, yes, it is the tears or tears of muscles and ligaments that often lead to pain in the shoulder.

Also, quite often the source of pain is the so-called acromioclavicular arthrosis – this is damage to the joint between the acromial process of the scapula and the clavicle.

More rare causes are inflammation of the shoulder joint capsule (adhesive capsulitis-see.Figure below), damage to the articular lip, fracture of bone structures, etc.

There are many reasons, treatment also has its own characteristics in each case. Therefore, from how we correctly establish the diagnosis, such an effect from the treatment will be.

During the appointment, I carry out a number of special tests. One of the main ones is the Dowborn test. You can do it yourself.
If you have pain when raising your arm in the range of 60-120 degrees, damage to the muscle that participates in shoulder abduction is quite possible.If pain occurs in the 160-180 degree range, acromioclavicular arthrosis can be suspected.

In addition to examination, in diagnostics, ultrasound examination (ultrasound) and magnetic resonance imaging (MRI) help.

Treatment, as a rule, boils down to the use of non-steroidal anti-inflammatory drugs, physiotherapy (shock wave therapy copes better with these problems), the use of special exercises.