Ask a PT

156 Posts
 
Posted - 08/13/2007 :  13:04:38  Show Profile  Reply with Quote
Our user asked: "My shoulder has been looked at thoroughly with x-ray and MRI by an orthopedic surgeon. He couldn't find anything wrong with it, but that doesn't help my discomfort. I have a theory of my own, which I am looking for some support with. My right shoulder hangs a bit forward. When I correct this posture, it feels like it hitches on something and then clicks into place. It will not stay for even a moment though. I can't tell if it's the second or third rib in front, but this rib feels like it's tucked under the sternum. I've had this checked, and was told that, though it's not in the ideal position, it is not dislocated. Anyway, it also is raised up about a quarter of an inch in the back. I think that my shoulder blade is catching on the rib where it is raised in the back. Other than the mechanical motion of the shoulder, my symptoms are tightness and pain in the upper chest, upper back and the right side of my neck, especially at the front from the collarbone to my right ear, and general balance issues. I do doorway stretches and arm to wall stretches, which feels good at the time, but doesn't bring the rib out of the sternum or release the muscles for long. Is there anything else you could recommend for a rib/shoulder issue like mine? Thank you for any tips you can give me."

Ask a PT Response: "From my experience it is not too common for the second or third rib to affect mobility or create symptoms at the shoulder/neck joints. The 1st and 2nd ribs are atypical as they differ in shape compared to ribs 3 through 9 and can evoke symptoms if they are involved. Often times the 1st rib can affect shoulder/neck mobility and result in pain, numbness/tingling and tissue irritability if it pinches on various structures. You mention your right shoulder protrudes forward at rest and you experience a hitching sensation when you retract it. This sensation can be caused by many factors such as weakness of your scapular muscles, tightness of your chest or posterior shoulder muscles, shoulder joint instability, compromised joint mobility or poor neuromuscular integration resulting in improper biomechanics at your shoulder and neck joints. Some of the previously mentioned factors can result in less than proper positioning of your shoulder blade when it sits on your back/thoracic spine. Ribs 1-7 connect onto the sternum up front and the thoracic vertebraes in back. Therefore, they don’t allow for much freedom for movement. In your case, I believe involvement of the second or third rib is probably not likely. Pain and tightness at the upper chest, upper back and R side of the neck can suggest tissue imbalances. My suggestion for you would be to set up an appointment with a PT and have a comprehensive physical therapy evaluation be conducted so that he or she can determine the actual cause for your pain/discomfort. A problem list should be generated and the necessary actions taken to correct for those problems. Without physically examining you it would be difficult to recommend the most appropriate and effective exercises for your condition. Good luck and thanks for using CyberPT."