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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 29517
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I have stinging/burning pains (mild) in the chest wall, this

Resolved Question:

I have stinging/burning pains (mild) in the chest wall, this originated on the left and now is everywhere. I also have a sore shoulder which seems swollen and is painful.

I have had a chest x-ray (10months ago) + ultrasound of the upper and lower abs + shoulder.

I feel the doctor is not taking me seriously and that I could have something serious that we have not detected.

What should i do?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 3 years ago.

Greetings.

 

Do you have neck pain?

Are you shoulder movements painful?

Do you have breathlessness, tenderness in the chest wall?

Is there pain when you move your upper back or shoulder?

Were any investigations done?

Any significant past medical or surgical history?

Are you diabetic, have high blood pressure, are sedentary, stressed, over weight, smoker, take alcohol?

Is your cholesterol or lipid profile normal?

Any significant family history?

 

Dr. Arun

Customer: replied 3 years ago.

Thanks for getting back to me,

 

My neck seems to be ok, just hurts a little when I turn to the right (it is my right shoulder that causes most of the pain).

 

I have been able to use my arm and shoulder just like normal however if i lift something above my head my arm feels very weak and i tend to get the shakes at times.

 

My breathing seems to be ok, just a little weazy at the moment.

 

My upper back is ok, it is just the right side around the shoulder blade thats causing the problems, it feels kind of like a pulled muscle (however it just won't get better).

 

I went to the doctor months ago as i was getting the buring/stinging pains in the chest and it has worsened from then.

 

I have had no surgery that I can think of that would relate to this, the most recent thing i had ws my wisdom teeth removed last year.

 

I am not diabetic however this runs in the family, blood pressure is ok, my weight is normal, very light smoker used to smoke very heavy), I usually have a few drinks of a weekend.

 

Cholesterol level was a little high and this runs in the family however the GP i see told me that this should be ok.

 

Family history we have heart problems (father passed of an infacrt of the artery), diabetes, lung cancer and i think thats about it.

 

Hope this helps.

Expert:  Dr. Arun Phophalia replied 3 years ago.

Thanks for the detailed information.

 

Shoulder girdle is made of neck, chest and shoulder muscles and a problem in shoulder may radiate to the chest. The causes of consideration would be;

1) Bicipital tendinitis
2) Biceps rupture
3) Brachial neuritis
4) Rotator cuff disease
5) Cervical radiculopathy
6) Cervical spondylosis
7) Suprascapular neuropathy

Majority of people with above problems will respond to physical therapy alone. The program should be aggressive, daily and assisted by the physical therapist. The regimen consists of active and active-assistive range-of-motion exercises combined with stretching. Pain may occur early but within six to eight weeks progress is usually made. Other treatment modalities such as heat and massage may help. Nonsteroidal anti-inflammatory analgesics may also be beneficial. Deep electrotherapy in the form of short wave diathermy, Interferential current, trans cutaneous electrical stimulation, iontophoresis, phonophoresis also is very help initially.

Those people who do not respond to the initial physical therapy are considered for the following;

1) A subacromial corticosteroid injection

2) A glenohumeral intra articular injection

3) Surgery; arthroscopic or open surgery

Following investigations would be required;

1) X-ray of the neck spine and shoulder
2) MRI of the neck and shoulder
3) Nerve conduction velocity (NCV) study
4) Electromyography (EMG)

You can consult following specialists;

a) Orthopedist
b) MD in Physical medicine and rehabilitation

 

Having said that; with your history of high cholesterol and family history of diabetes, a cardiac (heart) evaluation is mandatory. Stress test and echocardiography should be done for ruling out any heart association of the chest pain.

 

Other causes to consider would be;

 

A) Costochondritis; it is inflammation at the junctions of rib and cartilage or with the breast bone / sternum. Local analgesic ointment, or spray, chest brace and warm compresses with Ibuprofen is helpful. Another possibility is muscle sprain. Please read about the costochondritis;

http://www.mayoclinic.com/health/costochondritis/DS00626


B) Pinched nerve in the neck can also cause chest pain. A physical examination by a doctor is usually able to give concrete clues to the diagnosis.

C) Myofascial trigger point; they may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event (say violent cough) or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. Myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression.

Please feel free for your follow up questions.

Dr. Arun



Edited by Dr. Arun Phophalia on 8/30/2010 at 5:32 PM EST
Customer: replied 3 years ago.

Thanks Dr Arun

 

I had been looking online at some of these possible causes and was just worried as I have been having these problems for the last 10 months.

 

Would you be able to help me with the following?

 

Could working night shift 10pm - 6pm (5 days) permantly be having an effect on me?

 

Should these sympoms last for this long if it is Costochondritis related?

 

I have also been feeling a little unwell (tired, weak and generally not thining clearly), just wondering if this could be associated with this as well? (again this could be partly because i work nights however this seems to be getting worse).

 

Thanks again

 

Expert:  Dr. Arun Phophalia replied 3 years ago.

You are very welcome.

 

The permanent night shift can be definitely related to it. Costochondritis if not managed properly can last very long. The fundamental here in your case is to confirm, whether it is a musculoskeletal issue and not heart related. All of the musculoskeletal issues are treated on the similar line and physical therapy has an integral component of the management. So shoulder joint problem, myofascial trigger point, costochondritis, pinched nerve in the neck etc will have some common way of treatment. Your tiredness, weakness and difficulty in clear thinking is due to the night shift and this needs to be changed as the first step for over all well being.

 

It is pleasure and privilege assisting you.

 

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 the answer. Good luck!

 

Dr. Arun

Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 29517
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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