Basant Puri et al. report ‘potential clinical sign’ for ME/CFS

Increased tenderness in the left third intercostal space in adult patients with myalgic encephalomyelitis: A controlled study
– Source: Journal of International Medical Research, Issue 1, 2011

By Basant K Puri, et al.

[Note: To read the full text pdf of this brief open access article, go to An intercostal space is the space/muscle tissue between two ribs. Though our impression reading the article was that the tenderness was in the front of the rib cage, one reader notes the article does not indicate whether the tender spot between these two ribs is anterior (front) or posterior (back) of the thorax, and suggests it is more likely to be in the back.]

A clinical sign has not thus far been associated with myalgic encephalomyelitis (ME).

The present study involved systematic clinical examination that included inspection, palpation, percussion and auscultation of the thorax of 42 ME patients and 20 age-matched healthy controls while sitting.

Left lateral third intercostal space* tenderness was noted in 34 (81%) of the patients and in none of the controls, a difference that was highly statistically significant. [If a subject in the study had this tenderness, it was “100% indicative” of ME.]

This finding may be related to changes in lymphatic function and to the descending course of the thoracic duct.

[Note: according to Wikipedia, the thoracic duct is the largest vessel in the lymphatic system. It collects much of the lymph (interstitial fluid) in the body from smaller vessels, starting in the abdomen, and drains it into the bloodstream via the subclavian veins (behind the collar bones). Circulation of lymph fluid through the body depends on muscle movement, breathing, and gravity.]

Further studies, preferably blinded and combined with appropriate imaging, are required.

Journal of International Medical Research, Issue 1, 2011;39(1):212-4. PMID:21672323, by Puri BK, Gunatilake KD, Fernando KA, Gurusinghe AI, Agour M, Treasaden IH. Imaging Department, Hammersmith Hospital, London, UK. [Email:>]

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One thought on “Basant Puri et al. report ‘potential clinical sign’ for ME/CFS”

  1. IanH says:

    I have found this to be true but there are some patients with wide spread pain, such as in MS and non-ME trauma induced Fibromyalgia who also have this third intercostal pain on palpation. So some better controls are needed before we assume it is an exclusive marker.

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