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I have been seeing doctors for close to 8 months now for…

I have been seeing...

I have been seeing doctors for close to 8 months now for pain in and around my ribcage. It all started on the left side, around ribs 7,8, and 9. mostly just in front. I've been diagnosed with all sorts of stuff. then I developed lefsided back pain around same area. I've been a very active person my whole life. athletics are very important to me. I was doing weight lifting and heavy cardio before all this happened, and have been taken out of all activity now for 8 months. The latest specialist I am seeing is a Physiatrist who has diagnosed me with possible Intercostal Neuralgia. They will be performing a nerve ablation on T7,8 and 9 in a couple days, and I'm wondering what my protocol is for that if I will be able to return to exercising

Doctor's Assistant: Have you had any recent injuries? What seems to make the pain better or worse?

But my most recent concern, is that I have a significant divot in my left side in that same area that looks like what my Physical Therapist described as major muscle atrophy, that she said can be caused by the nerve not sending the right messages to the muscles is that right? I'm a thin person, so its easy to feel my ribs, but I've noticed over the last recent months, that left side just feels like skin and bone right over that 7th or 8th rib, as compared to the right side which seems to have more "mass" over them its just been a very perplexing occurrence that no one can seem to figure out, and I'm wondering if I should maybe set an appt with a rheumatologist??

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Nothing of concern, no

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Answered in 15 minutes by:
2/16/2018
Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,727
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Hello,

Have you had a MRI of the thoracic spine?

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Customer reply replied 5 months ago
thoracic spine looks fine
Customer reply replied 5 months ago
I've had several X-rays and a bone scan which all came back normal

OK.

Well - after that type of procedure, you can generally return to your normal activities as tolerated. You may want to take a few days off, but in general there wouldn't be any specific restrictions to returning to exercise.

Because your MRI does not show any disc herniations or "stenosis", there isn't a danger of paralysis or something similar which would cause an activity restriction.

The muscle atrophy -- the divot inbetween the ribs -- can be a sign that the nerve is not functioning correctly to that area. Rarely, a thoracic herniated disc can "pinch" a nerve and cause pain (and potentially atrophy), but since you had a clear MRI, this is not the case here.

A rheumatologist probably would not be the right specialist for this specific issue, because a overall issue, such as rheumatoid arthritis, or lupus, or other general conditions would not specifically target just the left side over a specific rib.

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Customer reply replied 5 months ago
Can Intercostal Neuralgia cause muscle atrophy
Customer reply replied 5 months ago
Can I attach a picture

Yes, if something is causing the nerve to function abnormally, then it can cause atrophy in the muscles it innervates.

Similarly, a nerve getting pinched in the neck (cervical radiculopathy) can cause weakness and atrophy in the arm muscles.

Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,727
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Customer reply replied 5 months ago
if the intercostal nerves of t7,t8, and t9 undergo ablation, will the muscles no longer function?
Customer reply replied 5 months ago
for example, I have read that the intercostal nerves are somehow connected to the abdominal muscles including the obliques, if those nerves are no longer functioning, will that cause problems for the muscles?

If they are undergoing ablation to the nerves themselves, then they may no longer function.

This can cause the sensation of numbness in that area of the thorax (which is often tolerable, and shrinks with time). The muscles innervated by those nerves can atrophy -- so you may notice a slight change in the obliques, the intercostal muscles, and some of the muscles of the back (although because muscle innervation overlaps considerably, you may not notice much of a difference in this area)

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Customer reply replied 5 months ago
exercising those muscles post procedure is safe to do?

I don't see a problem with it. Of course, you should ask the doctor performing the procedure the same question, because they may be doing something special in which they may want you to take it easy for a while.

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