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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 32156
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a stabbing pain in my side for two weeks. It is sometimes

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I have a stabbing pain in my side for two weeks. It is sometimes on my back directly beneath my right shoulder blade and sometimes in the front directly below (or on) my right breast. It comes and goes- is generally the worst in the morning and subsides at night. It is aggravated by coughing, sneezing or deep breathing. I can barely walk up two flights of stairs as the pain in the front becomes excruciating and it is difficult for me to walk as I get out of breath easily. (possible due to slow heavy breathing to prevent pain) The only comfortable position for me is lying down. I have seen a GI to rule out gall stones and have also seen a pulmonologist. My chiripractor is also baffled as she was sure it is gall stones.



Are you on any medications?

What are the investigations done?

Is there any tender point (pain on pressing)?

What are the treatment done?


Dr. Arun

Customer: replied 7 years ago.
I am a 45 year old female- am not on any medication (although I sometimes takeNexium for my hiatal hernia) I've had a CT scan of abdomen and pelvis to rule out gall stones, MRCP and Ultrasound of that same area also to rule out gallstones and endoscopy which showed a hiatal hernia but nothing else significant (These tests were done 6-12 weeks ago as I had pain 3 months ago(In January) in the stomach area and dark urine - blood work showed extremely raised amylase and other things related to the gall bladder, pancreas and liver. All pain subsided within 2 days and all that bloodwork has since come down to normal and the only one slightly elevated is amylase which is 132. (It has been slightly elevated 15 years ago too so that is probably normal for me) An ultrasound of abdomen and pelvis was repeated on April 27 to rule out gallstones again as these other pains began on April 16. (although they are totally different from the pains I had in January). When the pains originally started, my right breastbone was quite tender and is actually still somewhat tender to the touch. My chiropractor has tried adjusting me but it has not helped. I have not done any other treatments as I do not know what to treat or how.



A consideration of costochondritis can be done, which is inflammation at the junctions of rib and cartilage or with the breast bone. Anti-inflammatory analgesics (Ibuprofen), local analgesic ointment, or spray, chest brace and warm compresses are helpful in this. Though, with a hiatus hernia, one has to be careful with the analgesic and has to be give with the acid blockers. Read about the costochondritis, in this resource;


A chronic costochondritis also respond to the deep electrotherapy (done at physical therapy centers) like TENS (trans cutaneous electrical stimulation), phonophoresis and iontophoresis.


Polychondritis is another diagnosis and sometimes this may be associated with raised counts or abnormalities of the metabolic panel. If your echocardiography has not been done, it should be done to rule out pericarditis, with your clinical manifestations and history of enzyme changes related to the liver and pancreas. Pleurodynia would be the another possibility. Tietze's syndrome should be considered in the differential diagnosis, which is characterized by nonsuppurative edema (swelling).


Please feel free for your follow up questions.


Dr. Arun

Customer: replied 7 years ago.
Thank you for your answer- I have a few questions- I've had my lungs listened to by a pulmonologist- would he have picked up on costochondritis, polychondritis or pleurodynia. (By the way, what are the latter two conditions?) Also, what is pericarditis? Armed with this information you have given me, what kind of doctor (or specialist) would you recommend I see? Also, what causes these conditions and are they related to the hiatal hernia? How are they related to my other abnormal enzymes that we have seen in the past? Thank you



Pulmonolgist, or any physician unless, looking for the costochondritis specifically will miss it. He is otherwise also looking and hearing for the lung pathologies. Polychondritis is an immune mediated condition and can involve some organs with it. This occurs is differing severity in an individual. In your case it is not likely but is an important consideration to look for it in ongoing symptoms for so long. Read about it;


Pleurodynia is an illness characterized by fever and paroxysmal spasms of the chest and abdominal muscles. This is caused by group B coxsackieviruses.


Mild hiatal hernia is not likely to be related to your manifestations.


It is pleasure and privilege assisting you.


Dr. Arun

Customer: replied 7 years ago.
can you recommend where I go from here?



Your primary health care provider is the best to diagnose the costochondritis, if you are comfortable with him. Otherwise go to an orthopedist to rule out or rule in this diagnosis. If this is the diagnosis, it is not difficult to treat. If it is not, consult an internist for an evaluation for heart and pericardium (covering of the heart) and to look for other chest diseases.


I hope this was helpful to you. If it was, please remember to ACCEPT the answer so I can get compensated for my work. If you have any more questions, please feel free to ask. I am truly privileged to help you, and I want to make sure that you are satisfied with your answer. Good luck!


Dr. Arun

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Thanks for the feedback and bonus. You can open this thread anytime or ask a question on the site specifically asking for me.


Dr. Arun