I looked for notes about my original diagnosis and found a Google Docs document entitled Spine Injections and Imaging. Here are the contents…
MRI Thoracic Spine Without Contrast (7/26/2011)
Impression: 1. Mild anterolateral disc protrusion and endplate spurring at T8-9 and T9-10. 2. Mild C6-7 spinal stenosis. 3. Otherwise negative MRI of the thoracic spine.
Medial Branch Nerve Block (1/18/2012)
Dr. Hattori
Preoperative and Postoperative Diagnoses: 1. T10-11, T11-12 facet arthropathy. 2. Thoracic pain.
Procedure: Left T10-11 (T11) and left T11-12 (T12) medial branch nerve block
“Patient had undergone previous Medial Branch Block at T9,10 but felt injection was too high/”low” despite radiographic evidence. “Dr. Schofferman has recommended Medial Branch Block T10-11 and T11-12”
MRI T-Spine wo Contrast (7/9/2012)
Chronic Mild Schmorl’s nodes are present at T9 and T11. Mild disk height loss at T9-10. Mild to moderate facet arthropathy from T9-10 to T11-12 without significant foraminal narrowing.
Facet Rhizotomy January 2012 Dr. Gamburd
mixed results, some improvement for a few months
O’Neill Initial Assessment 12/10/2012
“Mild tenderness to palpation at approx T10/11” (2013 followup notes tenderness to palpation at T9/10). Imaging shows mild degenerative disease at T9/12 and facet arthropathy at T9/10, T10/11, T11/12.
“Partial response to rhizotomy indicates facet joints may be part of the problem but not the whole problem. Costovertebral and costotransverse joints may be a source of pain. Another possibility is nerve root irritation from the lateral recess compromise.”
Selective Nerve Root Injections (2/26/2013)
Left T9/10, T10/11 and T11/12
Followups: “Those definitely helped him, although for not more than a few weeks”. “Greg has chronic thoracic pain that is probably mechanical, although there could be a neuropathic component.”
“It seems we have zeroed in on the source of Greg’s pain which is in the thoracic spine somewhere between T10 and T12 on the left.” “Given the definite but partial benefit with selective nerve root injections, repeat nerve root injections could be helpful. The other option would be to inject the joints between the ribs and the vertebrae which have not been treated before.
Costovertebral Joint Injections Left T10,11,12 (12/23/2013)
(no followup but from what I remember these weren’t especially helpful)
My Impressions:
““Partial response to rhizotomy indicates facet joints may be part of the problem but not the whole problem. Costovertebral and costotransverse joints may be a source of pain. Another possibility is nerve root irritation from the lateral recess compromise.”
I think this is when we got away from the facet joints. Why we never came back to them is beyond me! Probably that blotched ablation. It hurts when they fry the wrong nerves, especially when they just partially fry them around your whole body. Oh well, it would suck to get ablations every couple of years. Those fucking nerves grow back. I’m just not sure nerve frying is the solution to anything. I suppose they need some desperation options other than opiates. Maybe I just got a bad one. Oh well, that will probably be my next Hail Mary if this Hansen 3.0 doesn’t work.
All of this T9 – 12 stuff has me worried though. I’m supposed to be hurting at T8. He (as well as AI) said that I could have symptoms from my hypermobile 10th rib, even though it’s congenital and thus I suppose, my 9th. It would explain why I don’t have pain at my 9th rib tips. It would all makes sense if The Pain and those blobs were at level 8 and not level 10. But what if my ribs are the problem? I mean, they’ve been jerked and pulled around by my sports, my hernia, the 2nd surgery. Like this article says, there’s a lot moving around in there when your 10th rib is floating.
Dr. Rowan Paul’s Office Visit
Office Visit Note
Patient Name: Gregory Payne
D.O.B.: 08/01/1960; 64 yrs, 7 mo at the time of visit
Seen by Rowan Paul, M.D.
Date: 03/05/2025
Exam Reason (CC): SF MSK EST FU
History of Present Illness
Gregory is a 64 year old man here for left lower rib pain. Feels like his pain was posterior but more unstable. Sharp knife in the back, then flank ache and has had negative rib fractures. 9./10 in the morning, has to take Methadone, Cymbalta. 4-6/10 now.
Cortisone injections was helkpful for 4 hours from the anesthetics. Steroids didn’t work.
Weakened abdominal muscles. History of diastasis recti.
Bone scan remotely was negative.
Is going to see Dr. Hansen in West Virgina for Hansen technique
Otherwise as seen in the common Electronic health record, no change in past medical history, past social history, family history, medications, allergies
ROS:
CONSTITUTIONAL: Appetite good, no fevers, night sweats or unintentional weight loss.
HEENT: No headaches, diplopia, eye pain, ear pain, tinnitus, nose bleeding, mouth sores, or jaw claudication.
CV: No chest pain, shortness of breath, dyspnea of exertion, or peripheral edema.
RESPIRATORY: No cough, wheezing, or dyspnea.
GI: No nausea/vomiting, diarrhea, abdominal pain, or change in bowel habits.
GU: No dysuria, urgency, or incontinence.
NEURO: No motor weakness or sensory changes
SKIN: No rash or photosensitivity.
MUSCLE-SKELETAL: No morning stiffness, Raynaud’s Phenomena, Positive joint pain/ muscle/tendon pain as above ENDOCRINE: No polyuria/polydipsia, no heat or cold intolerance
on exam the patient is in no apparent distress
Psych: alert and oriented,
lungs with non-labored breathing, no audible wheezing or tachypnea.
Neck is supple, trachea midline.
Extremities are warm and well-perfused, no clubbing cyanosis or edema.
Heart regular rate and rhythm,no varicosities
Skin with no visible skin lesions or lacerations. no erythema.
Neurovascularly grossly intact with full motor and sensory function besidesbelow. DTR 2+ bilaterally Patellar and Achilles, nonantalgic gait
MSK: general palpable unstable T eight,nine and T9 T10 articulation, That is tendered Touch. he also has tenderness in the T 9, T10 and to illustrate T11 costotransverse regions.
Completes nonvascular real time ultrasound examination clearly shows instability, of the T8 and T9 articulation front and back, T9 and T10 significantly in the front. I do not see major instability at T10 T11 though he does have pain under the ultrasound probe. underlying lung looks intact.
Impression/ plan #1instability, of the T8 and T9 articulation front and back, T9 and T10 significantly in the front. Likely post traumatic in the setting of Ehlers Danlos syndrome.
I recommend a dextrose based prolotherapy And Shockwave therapy as well as Class for high potency robotic assisted laser and EMT. he and his wife were minimal after risks and benefits were explained. I recommend to treating both Anchor and posteriorly based on his biomechanics. He could opt to do surgical stabilization as well.
Was crept with chlorhexidine times three. under direct needle ultrasound guidance with image documentation using a sterile 6 to 15 megahertz ultenrobe by advanced at 25GAGE needle in long axes and then short axes and injected the T8T9 and T10 cost of transverse joints posteriorly. I then injected the anterior slipping rib at T8, T9 and T10 with 4ml of 12.5 % dextrose, 2 ml of 0.2% ropivicaine.
MLS Class 4 laser neuritis setting front and back.
The patient tolerated the procedure well, no complications. Lungs CTA bilaterally after. Felt much better after. No pain.
See back in 6 weeks.
Patient was advised to seek urgent medical care if they develop any sudden worsening pain, weakness, parasthesias, bowel or bladder incontinence, saddle anesthesia, headache, fever, or chills. Medication precautions given. Conservative measures explained in detail. Activity modification discussed in detail Patient is amenable to treatment plan. Questions were answered. healthy lifestyle explained. Thank you for the opportunity to take care of this patient.
Assessment/Plan
1. Slipping rib syndrome
2. Thoracic back pain
3. Fascial defect
4. Abdominal pain
Electronically signed by Rowan Paul, M.D. on 03/05/2025 1:09 pm in 
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