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Rib Cage Symptoms with Metabolic Involvement

Exit forum ID Forum Discussion Rib Cage Symptoms with Metabolic Involvement

This topic contains 4 replies, has 3 voices, and was last updated by   Christopher Stepien December 25, 2019 at 12:59 pm.

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    Christopher Stepien

      25 YO female
      Left lateral lower rib cage
      Q: Sharp, tight, “feels like it’s going to snap”
      I: 5/10 when provoked (3/10 at rest)
      Prov: heavy breathing, when bloated from eating, any CrossFit or strength workout
      Pall: rest, squeezing the ribs

      Dx Hypothesis:

      1. Intercostal rib adhesion
      2. Something else ???

      2nd Order Hx Points

      O: April 2019 (suddenly), the day after going off antibiotics from an infection in her tooth.

      After April 2019, had fluid around her left lung and heart. A few weeks later, a pulmunologist said the fluid was gone. MRI chest and spine said “fine”. The pain, IN APRIL 2019, was also under her left clavicle, in her left pec and under her anterior left lower ribs (all of this is suggestive of LUNG involvement to me). Said it felt like “cheerios” over her lower ribs when she breaths (maybe suggestive of instability?)

      In May 2018, diagnosed with idiopathic urticaria angioedema (no fever, but hives and swelling).Was on 15 meds/day. Was able to go off them when she went on an anti-inflammatory diet. She was in bed almost all day from May 2018 to Sept 2018.

      Had depression from 15-22. Scarlet fever at age 11. Tourettes syndrome at 12. Diagnosed with epstein barr in May 2018 (but no signs of it).


      TF: full
      TR – R: 74 deg, 134% – mild tightness left ribs
      TR – L: 59 deg, 107% – mild pain left ribs (At Treatment 1, this regressed to 48 degrees with severe pain – suggestive of inflammation somewhere restricting this motion)
      SA – of – No symptoms
      Scap E/D – Full – no symptoms
      Cervical LF with Shoulder depression – full, no symptoms
      Palpation: Moderate adhesion in intercostals, NO adhesion in Left QL

      – Standing and taking heavy breath (4/10)
      – Standing, laterally flexing lumbar sine to right with left arm overhead
      – (5/10 tightness at CCx)

      Post-Exam Diagnosis:

      1. Intercostal adhesion due to fluid around lungs from antibiotics
      2. Metabolic


      1. Am I missing anything?
      2. After 2 treatments, I felt minimal adhesion in her intercostals left. I’m going to check on her at home and tell her NOT to come on for visit 3 if no other relief.


      Seth Schultz, DC

        Did you do FastMap for her Chris?


        Christopher Stepien

          Doing now. TY for reminder of Fast MAP Seth.

          I assume “established pattern” means “sclerotegous” or “dermatomal” referral pattern?

          75% functional/structural
          40% metabolic/psychological

          Where would I go from here?


          Carl Nottoli, DC

            Hey Chris,

            Established pattern means sclerotome, dermatome, peripheral nerve, or myotome. I suggest watching a refresher on the Fast Map webinar.

            Lots to unpack here. Her initial Sx primarily pointed to the metabolic issue as the culprit. She has great ROM and constant pain.

            I think you did the right thing by treating what adhesion was present in the region, and stopping as soon as you suspected something else. There’s a possibility that the innermost intercostal muscles have adhesion. These are deep to the external and internal intercostals, responsible for forced expiration now may be having difficulty expanding properly. I’m not sure if we treat these with MAR. There also may be other connective tissue adhesions internally from the inflammation that cannot be treated manually.


            Christopher Stepien

              Very helpful Carl.

              I will watch the Fast Map webinar! TY for input.

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