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Neurology (Expert Forum)
unusual fracture of 3rd rib
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unusual fracture of 3rd rib
by amy__0__0, Aug 28, 1998 12:00AM
Two years ago I was injured by being pulled down hard by my left arm. The initial diagnosis was rhomboid strain. After several months, I went to a physical therapist, who sent me to a spinal surgeon when she couldn't fix the problem. He then sent me to another physical therapist, and eventually I was sent to a physiatrist who did many steroid injections, which made the pain worse. The spinal surgeon then sent me for prolotherapy injections, which were awful and made the pain worse. Another physiatrist/anesthesiologist suggested a bone scan, which showed unusual activity at the third rib near the spine. A CT scan clearly shows a fracture with non-union and pseudo-arthrosis at the costo-vertebral juction. I can't find a doctor who has ever seen this before. It causes severe pain and also muscle spasms and constant headaches. After more painful injections, my surgeon wants to remove the fractured bone. I have been sent to several physiatrists since they discovered the fracture, and they have no other suggestions besides cutting or "killing" the nerve or acupuncture. My concern is the possibility of nerve damage. All of the doctors have been extremely negative about the surgery. I do not want to make it worse by damaging the nerve, but I can't live with it like it is. I take painkillers constantly, have been on light-duty and have now been out of work for 4 months,and stand to lose my career as a police officer. Has anyone ever heard of this or had similar surgery for a different problem? Any help would be appreciated!
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I think you need a second opinion from an orthopedist who is experienced in complex cases. I don't know if our orthopedic doctors have seen this particular type of problem before, but I suspect chances are high. At least in the neurology department, we see and recognize problems which don't cross the paths of other neurologists, so one could expect the same of the orthopedists.
Also, I suspect the orthopedist here would be as conservative as appropriate in terms of suggesting what to do. If surgical repair seems appropriate, they'll tell you so. If they do opt for surgery, chances are that they have done one like it before.
This type of injury is beyond my experience, and I think most neurologists would agree that an orthopedic surgeon should be in on the evaluation. You may also be referred to the pain management clinic, but the first stop should be ortho. The main number at CCF is 800 223-2273. Ask for orthopedic surgery clinic appointments, give them a bit of background so they'll know if there is an appropriate staff specialist who should see you. I hope this helps. Good luck. CCF MD mdf.
