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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18201
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello - I have used 'Just Answer' before, on varied topics,

Resolved Question:

Hello - I have used 'Just Answer' before, on varied topics, so have thought of approaching you now ..
My Daughter-in-Law, aged 32, has told me that one of her ribs 'pops out' at times, with no apparent warning .. she puts this back in herself and the situation causes more of a 'funny feeling' than pain.
This Lady is of slim build and does not exercise due to lack of time / inclination, but she does spend many hours behind the wheel of her car for work purposes.
She has recently approached her GP, who was puzzled and approached 4 other Doctors who were equally so.
The GP asked this Lady to photgraph the next occurrence, which she asked a female work colleague to do, but the resultant picture showed nothing significant.
Have you any advice?
Should my Daughter-in-Law approach a Physio rather than a Doctor?
She is, of course, a little worried, because she has a young child and her own family are concerned in case the 'popping rib' is a sign of something bad.
I would be most grateful for your opinion on this matter.
Regards
Lynne Barrow.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.

There are several options at this point.

Yes, a Physiotherapist would be a reasonable consideration. It also would be appropriate to consider a physician that specializes in the musculoskeletal system, such as an Orthopaedic Surgeon or a Physical Medicine and Rehabilitation Physician, also called a Physiatrist.

I also may be able to have some advice about management, but that would require some further information.
Where is the location of the rib that pops out? Front? Back? Upper rib? Lower rib?
Has she noticed any particular action that tends to cause it to pop out?
Does she have joints that seem to be more flexible than most people?
Customer: replied 2 years ago.

Thank you, ***** *****

This Lady showed me the Rib in question two evenings ago ..

It is a Front Rib, and, seemingly, the uppermost one,on her right hand side.

She offered to pop it out herself as a demonstration, but I declined this offer!

I can't specify any particular situations / actions which might trigger the problem, but this Lady works under a lot of stress ..

One occasion was at a recent Family Christening ..

She is currently undergoing a bad patch with her partner (my son) ..

So I wonder whether stress might be to blame for an inherent weakness surfacing?

I don't know whether this Lady is 'double-jointed' ..

I hope that the information I have given you is sufficient for you to advise regarding the situation which is, quite naturally, making her feel vulnerable, and less able to conduct her job, within which she is a Manager ..

I look forward to your reply ..

Lynne Barrow.

Expert:  Dr. D. Love replied 2 years ago.
This is in the area of a costochondral joint, which is the joint at the front where the rib attaches to cartilage, that then attaches to the breast bone. Problems with these joints most often happens after trauma to the chest. Has she had any recent chest trauma, such as an automobile accident?
Customer: replied 2 years ago.

I am not aware of any such occurrence ..

I have known this Lady for around 7 years, but cannot offer an opinion regarding her life before this time, which I understand to have been problematical ...

Should I ask her whether any such trauma has ever taken place?

Many thanks

Lynne Barrow.

Expert:  Dr. D. Love replied 2 years ago.
Let me explain the primary concerns in this situation, and then you can discuss these issues with her.

As noted above, the location that you describe is the location of the costochondral joint. The upper ribs have two joints - one in the back at the spine and the costochondral joint in the front. These two joints allow the ribs to move similar to the movement of the handle of a bucket.

For someone that is having separation or dislocation/subluxation of this joint, it is most often seen in someone with chest trauma. But it also usually would be a recent trauma if the symptom has only recently started.

Another possibility is that there is a problem with excessive laxity in the joint, also called hypermobility. This is most often seen in someone that has a general issue with hypermobility, which is usually a benign issue affecting many joints throughout the body. We actually see this more often causing symptoms affecting the extremities, although it also can affect the spine (causing scoliosis) or any joint in the body.

The general initial approach to either recurrent separation/dislocation or hypermobility of any joint is a combination of support of the joint, if possible, the application of local care, such as moist heat, and the use of an anti-inflammatory medicine, such as ibuprofen or naproxen. However, there is no reasonable method for providing support of the costochondral joint. Wearing a rib belt or elastic band can provide support, but it also can limit the ability to take deep breaths, which can lead to infections of the chest, so are usually avoided. So, for a costochondral joint, the local care and anti-inflammatory medicine are the usual initial interventions.

To be able to make the diagnosis, it may be necessary to see any of the practitioners noted above. But in cases in which the problem persists, it may be necessary to see an Orthopaedic Surgeon for consideration of whether a procedure should be done to stabilize the joint.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.

Thank you very much, Doctor ..

The young Lady in question is completely unaware that I have taken these steps on her behalf ..

I will inform her of your opinion within the next couple of days.

Would it be possible for our conversation to be placed with me as an Email, so that I can forward / print out?

I'm also wondering whether wearing a 'support vest' might help

in keeping the offending Rib in place, just for now?

Many Thanks

Lynne Barrow.

Expert:  Dr. D. Love replied 2 years ago.
I do not have the ability to generate an e-mail from the system, although customer service may be able to do so. When customers want a document to be able to print or forward, I usually recommend highlighting the answer and then copying and pasting the answer into whatever word processing software that you prefer.

Any support vest that is sufficiently firm to support the joint will have the same issue as the rib belts and elastic bands noted above, so would be better to be avoided. Sometimes, it may be unavoidable, but we usually try to avoid the use of such interventions.
Customer: replied 2 years ago.

Many, many Thanks!

I will do my best to pass your advice to the Lady in question.

Fondest Regards

Lynne Barrow.

Expert:  Dr. D. Love replied 2 years ago.
You're very welcome.

If I have answered all your questions, please remember to provide a positive rating so that I am credited for assisting you.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18201
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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