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  • grace
    Member
    Post count: 4

    Dr. Corenman, almost 4 months ago, I had an injury in the middle of the thoracic spine due to an improper spine manipulation by a PT. The PT said it is joint sprain. Since then, I have had pain in that area. It even caused the pain in the chest area since the manipulation was applied from the front in the middle of two breasts. At some point, I felt better. But later, it seemed to flare up again. It has been this kind of cycle for months. I am asking if this situation should be further checked. I am worrying that the injury may have got worse and start to hurt other part of the spine. Will that be possible? Thanks.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The pain could be from a “joint sprain” which is an injury to the facet joint. The pain could also originate from the disc or the costo-vertebral joint (where the rib articulates with the vertebral body).

    If you have had the pain for four months and it has not improved, an MRI would be the next test that could reveal if the disc is involved. If the facets are involved only, the MRI will be negative (facet mediated pain does not show up on an MRI).

    Dr. Corenman

    grace
    Member
    Post count: 4

    Thanks, Dr. Corenman. Your reply is very informative. The pain is mainly from the right of the injured location. Sometimes, I feel the pain in the rib muscle in the back (both sides). Also the pain is felt in the mediastinum area. If I press two sides of the breastbone under the second rib (I am not sure if it is the first or second rib, it is about three fingers distance from the collar bone), I can feel the pain on the spine where it is injured. Does this mean any injury to the tissue in the mediastinum area? That pain was so severe two months ago that I could not lift anything using the arms. Now the pain is a little better, but it is still there and I can see the skin color of the location where I pressed is a little darker than other areas.

    If the pain is caused by the injury to facet joint or costo-vertebral joint, is there treatment to help relieve the pain and help heal the injury? Will any complication happen if the injury is not treated at proper time? The long time pain has made me nervous because I was pain free before the injury. Thanks.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Most of the time, this pain is not dangerous. This is somewhat similar to an arthritic knee. It may hurt to walk on it but even if you climb Mount Everest, it won’t kill you.

    Pressure on the front of the ribs transfers pressure to the rib insertion on the spine. This may indicate a rib/vertebra articulation disorder such as a costovertebral joint injury. Radiculopathy can also create these symptoms.

    You pain is improving so you might just wait to see if the symptoms continues to improve. With four months of pain, you could ask for an MRI to look at the disc.

    Pain from the costovertebral joint is best treated by a chiropractor. Pain from the facet joint is also treated by chiropractic or by facet blocks. Disc pain is treated by therapy and epidurals.

    Dr. Corenman

    grace
    Member
    Post count: 4

    Thank you, Dr. Corenman. I really appreciate your reply and the forum you provide for asking questions related to spine.

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