Joint Preservation Blog

November 3, 2009

An upper back problem that looks like it’s abdominal pain…

Filed under: Uncategorized — Tags: , , , , — D @ 1:16 pm

abdomen_muscles

Jimmy was a teenage baseball player with a history of severe abdominal pain.  I think his case illustrates how many M.D.’s have lost our ability to structurally diagnose patients with chronic pain.  Since he had high abdominal pain below the ribs, he had the million dollar GI work-up for his abdominal pain.  He was ultimately placed on very high dose narcotics and other drugs by a local Childern’s hospital.  When he first came to our clinic, his pain was across the top of his stomach and he couldn’t sleep more than 1-2 hours a night.  He wasn’t eating well and had given up baseball (his passion).  What was striking on initial exam was that if this patient had an internal organ problem, you wouldn’t expect his upper abdomen to be tender, right along the rib cage.  When these lower ribs were followed to his upper back, he had muscle spasms in this area as well.  Since nobody had ever found anything wrong with little Jimmy’s internal organs, it was a safe bet that he had a lower thoracic problem leading to pain in the ribs, which masqueraded as a stomach problem.  Further exam in Jimmy’s case showed that the abdominal muscles had significant trigger points and the area that attached to the ribs had a significant enthesopathy (swelling at the tendons that attach to bone, due to excessive pulling on the attachment by tight muscles).  Our plan was to begin injecting the lower ribs with prolotherapy solution to allow these abdominal muscle attachments to heal and to get rid of trigger points in the abdominal and upper back muscles using an IMS technique.  Within 12 weeks (Jimmy had suffered for two years), Jimmy was back to playing baseball and without pain.  He went off all meds and at one year follow-up, he’s still off meds and without pain.  His case is a good example of how a simple musculosketal pain problem can be misdiagnosed, cost a bunch of money in expensive diagnostic work-up, and if undiagnosed and without proper treatment, would have led to a teenager addicted to narcotics.

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