Techniques for Rib Examination: Diagnosing Rib Stability Issues

Techniques for Rib Examination

Hello, Dr.
Sun.
I would like to ask you, if I have previously experienced external force that straightened my spine on both sides, what kind of examinations can I undergo to determine whether my ribs on both sides are resting on the vertebral bodies or have dislocated? I have instability in both my left and right ribs, and the thoracic surgeons in the southern region have performed standard frontal X-rays and told me everything is normal.
However, I constantly feel sharp pain at the junction of my spine and ribs, and I often feel as if something is dropping.
When I lie down, there is tenderness, which also affects the tension in my back muscles.
I have undergone MRI scans while lying down, and they also indicated normal results, so no further examinations were conducted.
An orthopedic surgeon took oblique X-rays and noted a possible fracture of the sternal manubrium, but the images overlapped, making it difficult to assess.
I would like to know if there are any examinations that can utilize lateral positioning techniques.
What methods can be used to check for rib dislocation from the vertebral bodies? I have been experiencing this twisting sensation on both sides for two years, and I am unable to find a diagnosis.
I am feeling quite hopeless.
Thank you.

Miss Zhou, 40~49 year old female. Ask Date: 2016/04/16

Dr. Sun Shengyi reply Radiology

General X-ray examinations related to the skeletal system are performed at specific angles for different body parts.
Due to overlapping factors, it can be challenging to detect subtle, non-fixed changes between the thoracic vertebrae and ribs.
If there is a possibility of unstable changes, different positions may need to be used for imaging to identify the issue.
If a standard X-ray does not reveal anything or if there are suspicious but uncertain findings, a computed tomography (CT) scan can provide more detailed, three-dimensional images of the bones.
However, due to the higher radiation dose associated with CT scans, it is recommended to have appropriate indications and objectives before proceeding.
It is advisable to visit a larger general hospital and consult a dedicated orthopedic surgeon to evaluate whether a CT scan would be helpful in identifying potential issues.

Reply Date: 2016/04/16

More Info

Hello! It sounds like you are experiencing significant discomfort and uncertainty regarding the stability of your ribs and their connection to your spine. I understand how frustrating it can be when previous examinations have not provided clear answers or relief. Let's discuss the diagnostic techniques that can help assess rib stability issues.

Diagnostic Techniques for Rib Examination
1. Physical Examination: A thorough physical examination by a healthcare professional is crucial. This includes assessing your range of motion, palpating the rib cage and spine, and checking for tenderness or abnormal movements. The physician may also perform specific maneuvers to evaluate rib stability and identify any areas of discomfort.

2. X-rays: While you mentioned that standard frontal X-rays have been performed, additional views may be necessary. Lateral (side) X-rays can provide a different perspective and may reveal issues not visible in standard views. Oblique X-rays can also be beneficial in assessing the ribs and their alignment with the vertebrae.

3. MRI (Magnetic Resonance Imaging): Although you have had an MRI that was reported as normal, it is essential to ensure that the MRI was specifically focused on the thoracic spine and rib cage. MRI is excellent for visualizing soft tissues, including muscles, ligaments, and cartilage, which may not be visible on X-rays. If there are concerns about rib stability, a dedicated MRI of the thoracic region may be warranted.

4. CT Scan (Computed Tomography): A CT scan can provide detailed cross-sectional images of the rib cage and spine. It is particularly useful for identifying fractures, dislocations, or any structural abnormalities that may not be apparent on X-rays or MRI. A CT scan can also help visualize the relationship between the ribs and the vertebrae more clearly.

5. Ultrasound: In some cases, ultrasound can be used to assess the soft tissues around the ribs and spine. It can help visualize any fluid collections, hematomas, or other abnormalities that may be contributing to your symptoms.

6. Bone Scintigraphy (Bone Scan): If there is suspicion of an underlying bone pathology, a bone scan may be useful. This technique can help identify areas of increased metabolic activity in the bones, which may indicate inflammation or other issues.

7. Electromyography (EMG) and Nerve Conduction Studies: If there is a concern about nerve involvement or muscle dysfunction, these tests can assess the electrical activity of muscles and the integrity of the nerves supplying them.

Next Steps
Given your ongoing symptoms and the fact that previous imaging has not provided clarity, it may be beneficial to seek a second opinion from a specialist in musculoskeletal disorders or a thoracic surgeon. They may recommend a more comprehensive evaluation or additional imaging studies tailored to your specific concerns.

It's also important to communicate your symptoms clearly, including the nature of your pain, any activities that exacerbate it, and how it affects your daily life. This information can help guide the diagnostic process.

Conclusion
Rib stability issues can be complex, and it may take a combination of diagnostic techniques to arrive at a definitive diagnosis. Don't hesitate to advocate for yourself and seek further evaluations if you feel your concerns are not being addressed. Your health and well-being are paramount, and finding the right answers is crucial for your recovery. If you have any more questions or need further assistance, feel free to ask!

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