Understanding Persistent Rib Pain Despite Negative Imaging Results
A woman in her late 40s is facing a perplexing issue with lingering discomfort in her ribs. Here's a summary of her situation: Two months ago, she experienced a tight embrace from a friend, which she believes initiated her pain. That night, she woke up with significant discomfort while shifting in her sleep, prompting her to visit urgent care the following day. During that visit, X-rays were taken, revealing what the urgent care doctor initially thought were about seven broken ribs. She was prescribed a combination of over-the-counter pain medications and scheduled for a Dexa scan the next day, which showed a bone density reading of -2.1. However, a few days later, a formal review by a radiologist contradicted the urgent care findings, indicating no signs of fractures on the X-rays. Consequently, her primary care physician (PCP) concluded that she was fine and advised against further investigation into osteopenia given her bone density results. Still concerned, she insisted on having a CT scan, which was conducted three weeks after the initial injury. Yesterday, she received the results, revealing again that neither the PCP nor the radiologist had found any fractures, lesions, or other abnormalities that could account for her ongoing pain. Her primary concern now is understanding the persistent pain she feels in three specific areas of her left rib cage: the lower front, the upper back near her spine, and the lower left side toward the back. While she began tapering off the acetaminophen and ibuprofen that she had been taking since week three, she still occasionally uses a lidocaine patch on the upper back area. She describes the pain in that spot as sharp, in contrast to the other regions where the sensation is more of a dull pulling. Although it's evident that she is improving, she does not feel completely healed. Given that her imaging tests have shown no clear issues, she is left wondering why the pain persists.
Answers (1)
8/7/2025, 10:20:48 AM
OpenHealth AI
It sounds like you’re experiencing ongoing rib pain that is frustrating, especially after multiple imaging tests have shown no obvious cause. Your situation is not uncommon, and there are several potential factors that could contribute to your persistent discomfort. Let's break this down and focus on managing your symptoms and enhancing your recovery.
Main Points
- Understanding Persistent Pain: The absence of fractures in your imaging does not discount the possibility of muscular, ligamentous, or nerve-related issues near the rib cage.
- Pain Management Strategies: There are effective strategies to help manage and reduce your discomfort.
Explanation
Even if imaging studies show no fractures or abnormalities, it's possible that you might be dealing with muscle strain, costochondritis (inflammation of the cartilage connecting the ribs to the sternum), or irritation of the nerves in the area. Over time, injury signals can result in lingering pain, even after the initial cause appears to resolve.
Actionable Next Steps
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Continue Gradual Pain Management:
- Continue using the lidocaine patch on areas where you feel sharp pain as needed. This can help alleviate localized discomfort.
- If the over-the-counter medication is being tapered off, consider using it intermittently for flare-ups only, while monitoring its effectiveness.
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Gentle Stretching and Strengthening Exercises:
- Start with gentle stretching exercises specifically focusing on the thoracic region (mid and upper back).
- Incorporate breathing exercises to help stretch and relax the muscles around your rib cage. For instance, deep diaphragmatic breathing can also alleviate tension.
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Physical Therapy:
- Consider engaging in physical therapy to establish a tailored rehabilitation program that might include guided exercises for strengthening the surrounding muscles and improving mobility.
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Monitor Symptoms and Reassess:
- Keep a symptom diary for a few weeks, noting what activities seem to flare up your pain and any improvements. This can help identify patterns and effective management strategies.
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Posture Awareness:
- Pay attention to your posture throughout the day. Good posture can reduce strain on your ribcage and surrounding muscles. Ergonomic adjustments at your workspace may be helpful if you work at a desk.
If you notice any changes in your symptoms, or if your pain worsens despite these steps, it might be worth discussing this again with your healthcare provider, particularly regarding further evaluation of your musculoskeletal health. Remember, recovery can take time, and it's important to be patient with yourself as you navigate this.
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