Question
pulled rib or serratus anterior
I was lying in bed and I turned quickly and I felt a grinding piecing pop feeling in my rib, under armpit  it scared me then I felt sore under arm level with the nipple on  outside of right breast 4 inches down from armpit, now the next morning, it is very sore. It does not pain or hurt to breath only when I cough or sit hard ,would triggers that popped make this sharp painful grinding noise then be so sore the next day. I have put ice on it., when I poke my fingers  into outside of my breast it hurts and stings, Does this really have to be a cracked rib or can muscle make that crunching noise and hurt like this.Is there anything I can do to make it better?
thank you

Answer
Hi Marj,

A muscle can make a popping sound. Usually at the junction of the muscle and tendon. This can be quite loud in larger muscles like the hamstring. However, in this case, you would have to assume it is the rib and not the muscle. It is possible that it is the muscle, however, the serratus is a fairly thin muscle. So, stay away from exercising for now. Even if it is the muscle, ice for the first few days. If it is the muscle, this could be a strain, which is a tear. There would be bleeding and inflammation. Rest and ice it as much as possible. If it is a muscle, you should see some gradual improvement, as opposed to a fractured or subluxated rib.

So, until you can see a doctor or get to an ER for a quick x-ray (well the x-ray itself after waiting many hours), assume it is something with the rib. I'm not sure what problem you had prior with the rib that you said was worse, but try to take it easy. It may gradually improve if it is the muscle and that would be a good sign. So, rest, ice, Ibuprofen or similar if you can and you can use a topical like icy-hot.

Try not to worry, even if it is a rib problem, you will get better with treatment.

It is possible that a muscle tear could cause dysfunction and this would affect the rib(s) and you could hear some grating noises. Likewise, if it is the rib, muscles can go into protective spasm.

If it is from trigger points, you may feel some pain radiating into the little finger side of the arm into the hand. Try to breathe with your belly pushing out when you inhale. Don't lift anything heavy over your head. Try to clear your throat instead of coughing.

When you sleep, use 2 pillows - one under your affected arm like in this picture
http://www.necksolutions.com/images/sleep-position-arm.gif

Hold off on stretching or exercising for now. If it is the muscle, when it starts to improve, you can do an in the door stretch with some trigger point therapy or maybe some active release.

I hope you feel better and this helps to put your mind at ease, even if just a little.

Kind Regards,

Dr. Steve