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  • hart
    Member
    Post count: 34

    G’day Dr. Corenman:

    Following my injury, the 10th rib on the right side started “poking out” and getting in the way. As I have regained strength over the last year, this has become less of a nuisance. Recently, I have started to go to yoga class again. I am getting “pinched” with certain movements.

    I made this video of my dancing rib a month or so after my injury when the problem became apparent.

    ht tp://

    (There are 3 spaces in the url that must be deleted.)

    Is it clear what muscles are involved? Can you make any specific suggestions for strengthening these muscles? (There is much more bulk now than in the video!)

    Cheers,
    Hart

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You have a floating right rib that is more elongated than normal and it “catches” with lateral bending. I cannot tell if this rib was fractured and now free floating or if it is a congenital variant. It might be uncomfortable and an annoyance but appears not to be dangerous.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    hart
    Member
    Post count: 34

    Thank you for having a look. This floating rib became apparent 4-6 weeks after presentation of disc herniation at T9-T10. (I stayed very still for the first six weeks following presentation!)

    I have read up on costochondral separation of the false ribs. I have come to the conclusion that such an injury would take some doing…require substantial force. I suspect the tenth rib on the left is also a floating rib…I am fairly certain I can palpate the end of it as well…it is nicely buried though. I am convinced that I have floating tenth ribs on both sides which I have read is a normal variant. (I am not Japanese, btw.) Rib films and MRI of the abdomen (having looked at these, there must be more useful views!) were ordered by an internist. She didn’t have a clue what that was.I stayed pretty quiet though I had a pretty good idea even if I didn’t know how it got there! I refused contrast for the MRI, figuring it wasn’t indicated. I was given an oil filled marker to place over the “lump”. Radiology was essentially negative. (I think there was some edema reported in the area of the marker.) I find this puzzling given the defect in the surface anatomy.

    Incidentally, I promise, I will make copies of all imaging and get it off to you. I am procrastinating. It has occurred to me that it is inconsiderate not to supply the films! I keep telling myself I will make it to Colorado soon and try to get an appointment!

    That rib did not poke out like that before I acutely presented with this disc herniation! I am ABSOLUTELY certain of that!! Is it possible that I have muscle weakness as a result of previous T9 nerve root compression? (An MRI 8 months post presentation showed no nerve root compression and marked decrease in disc protrusion.) I am trying to figure out which muscles are involved in keeping that rib out of the way and how I can strengthen them. I have been told T9 has no motor supply. Does T9 have a motor supply? And if so, what does this nerve supply?

    I suspect there is some irritation of the intercostal nerve. At first, I attributed this neuropathic discomfort to the T9 spinal nerve but quickly figured out that different motions were involved.

    I any case, this is much improved just as you predicted. As I mentioned, the video is old and I don’t think I can make it do that anymore! Cutting it off, as some suggested, would have been a VERY bad idea!

    I am wondering whether floating 10th ribs made it easier for me to herniate at T9-T10. Note: this is my first such herniation. (There is an incidental 1mm herniation at C5-C6 with the typical degenerative changes. I had impact in flexion to the C-spine with a C7 vertebral body fracture a couple of decades ago.) X-ray of the L spine are completely normal.

    Hart

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    It is highly unlikely that this floating rib is the result of a radiculopathy. Motor weakness of that myotome would have also consisted of severe pain along that dermatome and residual numbness along that rib distribution. More likely than not, this rib is the result of both developmental propensity along with an injury (even though you are not Japanese).

    Floating ribs are not related to an increased chance of disc herniation.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    hart
    Member
    Post count: 34

    I HAD severe pain and numbness along that dermatome — on the front side of the body. There still seems to be some numbness although I am accustomed to it after all this time. I haven’t seen anyone interested in mapping out the numbness. (5 years previously, I had had a several month episode of a tuning fork sensation in the same distribution. No imaging was done.) In fact, I had NO back pain acutely! ONLY radicular pain of insidious onset. Several months into my rehabilitation, I developed a sore thoracic spine.

    TODAY, I will FedEx the radiology to you. I do apologize for not getting on it MUCH earlier. In the meantime, I’ll repost the MRI “Impressions”:

    January 2011:
    T9-T10 RIGHT SUBARTICULAR ZONE LARGE DISC EXTRUSION EXTENDING 4.7 MM POSTERIORLY AND 10 MM SUPERIORLY WITH RIGHT LATERAL RECESS STENOSIS AND MASS EFFECT ON THE EXITING RIGHT T9 NERVE
    (There was NO back pain at this time, only TERRIBLE front pain! I knew it was nerve root impingement.)

    November 2011:
    1. THE PRIOR EXAM OF 01/04/11 SHOWED A LARGE FAR RIGHT LATERAL DISC EXTRUSION WITH CEPHALAD MIGRATION OF THE EXTRUDED DISC. THIS AREA HAS SHOWN REMARKABLE IMPROVEMENT SINCE THE LAST EXAM WITH NOW ONLY A 3MM RIGHT LATERAL PROTRUSION AND NO DEFINED NERVE ROOT COMPRESSION.

    2. MILD MULTILEVEL DEGENERATIVE DISC DISEASE WITH ENDPLATE SPONDYLOSIS AND SMALL SCHMORL NODE DEFECTS T7-8 THROUGH T10-11.

    3. MINOR 1MM POSTERIOR ANULAR BULGING T8-9, T10-11 AND T11-12

    4. STABLE APPEARANCE OF A SMALL BENIGN SIGNAL ABNORMALITY WITHIN THE ANTERIOR T9 VERTEBRAL BODY.

    I accept the idea that I have floating 10th ribs! I was never aware of them. They never poked out or hindered my movement until this disc herniation. I remain convinced that this protruding 10th rib is related to the T9-T10 disc herniation. I accept that I most likely have always had “floating” 10th ribs but NOT a protruding right 10th rib! It is now much less protruding. I would like to make further progress because repetitive motion of that rib causes a vague gnawing discomfort (?intercostal nerve) that later keeps me awake at night.

    Thanks again for your help and for creating this forum. I have found many of the threads very interesting.

    Hart

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I have to stand corrected. It appears that you had a full blown radiculopathy of the T9 nerve and resultant weakness of the intercostal muscles associated with that nerve. The muscle weakness might have allowed the floating rib to be uncontrolled with movement and now protrude out. I can tell you that I have never seen this before. This is why I love this forum as I learn new things every day!

    Hopefully, this nerve will recover and the motor strength will return. If this nerve can recover, the nerve will grow down from the site of injury about one inch per month. I assume the length of the nerve was initially about twelve inches. You probably have developed as much recovery at this time as you can hope to.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
Viewing 6 posts - 31 through 36 (of 45 total)
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