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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
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Experience:  Medical Doctor Trained at a Top Academic Institution
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pain comes and goes just below rib cage. happens when sitting

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pain comes and goes just below rib cage. happens when sitting down and move back or forth (increases in intensity and then goes away). doesnt hurt when touch that area. Pain can be quite searing. Had it for a week and is getting worse.
Submitted: 2 years ago.
Category: Medical
Expert:  Coachrobmd replied 2 years ago.

Coachrobmd :

Hi, I'm Doctor Robert, a Medical Internist (MD) who deals with diseases of all organ systems. All my education has been completed in the US.

Coachrobmd :

The views expressed here are for educational purposes only and do not establish a physician-patient relationship. It is NOT intended to replace your own physician's advice or diagnosis. If this is an emergency, stop now and please call 9-1-1 or go to the nearest Emergency Room.

Coachrobmd :

Are you there? If so, NOW is the time to chime in so we can chat.

Coachrobmd :

Because I can NOT see, touch, speak with or examine you, nor do I have access to your complete medical history, labs, scans or medications, I will NOT be able to give you an exact diagnosis. If that's what you are expecting from me here, STOP READING NOW. Otherwise you may possibly give me a negative I EXPECTED MORE rating, which is not helpful. There are limits to what can be done across the internet. PLEASE keep this in mind as you read my responses.

Coachrobmd :

At age 34, that helps a bit. This is unlikely to be gall bladder or spleen issues.

Coachrobmd :

Searing pain is seen in costocondritis.

Coachrobmd :

costochondritis (see: http://www.mayoclinic.com/health/costochondritis/DS00626)

Coachrobmd :

This is musculo-skeletal pain that can be INTENSE.

Coachrobmd :

And it doesn't generally hurt when touched; only during DEEP breaths, and twisting/arching/moving the rib cage.

Coachrobmd :

Please realize this: I am limited to the information that I glean from your posts, as I can't see, talk to, or touch you. I can only give you my approach to the evaluation of your symptoms if you were in my office. That puts me at a disadvantage compared to your doctor who actually sees your body right there in the office. This is just the nature of advising across the internet. A specific diagnosis under these conditions is VERY difficult.

Coachrobmd :

You should

Coachrobmd :

1. try motrin four times daily take as directed on the bottle

Coachrobmd :

2. apply heating pads to the area (don't fall asleep on it as it can burn the skin)

Coachrobmd :

3. if it persist beyond one week, you should be seen for a Chest X Ray (CXR) as this COULD be an issue of the tissue that surrounds the lungs (the pleura), a rib FRACTURE, or fluid in the lung causing this. ALL are possible and treatment is different for all three.

Coachrobmd :

Are you there? If so, NOW is the time to chime in so we can chat.

Customer:

ok - its not tender to touch or lie on. just effects me when i move back and forth sitting down sometimes. The pain however can be intense and feels as though something is pushing/moving against something.

Coachrobmd :

Costocondritis does exactly that.

Coachrobmd :

It is caused by cartilage attached to the rib being sepearated or inflamed. VERY painful.

Coachrobmd :

I had it and could barely breath. Yikes!

Coachrobmd :

As long as you are NOT short of breath (SOB) then no Emergency Room visit is required at this time.

Coachrobmd :

If you DO become short of breath (SOB) it's straight to the Emergency Room, okay?

Coachrobmd :

Does this make sense?

Customer:

ok - it doesnt seem to effect me breathing - just when i move when sitting down.

Coachrobmd :

Then, do what I suggested and it may just work out.

Coachrobmd :

Does this make sense?

Customer:

thanks.

Coachrobmd :

But after one week, you NEED to be seen. This should be a self-limited issue that resolves with regular pain relievers.

Coachrobmd :

Any other questions I can answer for you today?

Coachrobmd :

I'm here for you.

Customer:

ok - seem to have had it a week and its got gradually worse. so likelihood is it will resolve itself with some medication?

Coachrobmd :

Yes, that's exactly correct. If no improvement after a week of heating pads and medications off to the primary care physician (PCP) to be seen.

Coachrobmd :

Do you follow me so far?

Customer:

fine thanks

Coachrobmd :

Chest X Ray (CXR) would be the test of choice

Coachrobmd :

============= If you would like any additional information or have more questions, please don’t hesitate to ask! Please remember to only rate my answer when you are 100% satisfied. If you feel the need to click either "BAD or POOR SERVICE" (or ONE or TWO STARS, depending upon your screen), please stop and reply to me via the CONTINUE CONVERSATION button. I will be happy to do everything I can to provide you with the service you seek. A rating of FOUR/FIVE STARS (or GOOD/EXCELLENT SERVICE) is how I receive payment for all the years of training that went into assisting you today. It would be most appreciated.

Coachrobmd :

Any other questions I can answer for you today?
CoachRobMD


Coachrobmd :

If not, A rating of FOUR/FIVE STARS (or GOOD/EXCELLENT SERVICE) is how I receive credit for all the years of training that went into assisting you today. It would be most appreciated. Bonuses are also welcome.

Customer:

no thats fine i think. if its just that then im ok! just have a week of uncomfortable pain when i sit - have to get a different job!

Coachrobmd :

And I hope you feel bettter.

Coachrobmd :

No, dont change jobs!

Coachrobmd :

Tough job market out there fella,and they ain't easy to find!

Coachrobmd :

Thanks for coming to JustAnswer.com. If you ever want me again for other medical issues, please go to http://www.justanswer.com/medical/expert-coachrobmd/ and in the box beneath my photo, type FOR COACHROBMD ONLY!!, followed by your question. That way other experts won't answer it unless I'm away for a day or more. If they do try to answer, you can always respond that you're waiting for me to return. Have a great day.

Coachrobmd :

Are you stuck in the IM Chat room? If so, I can help you get out.

Customer:

yep - how do i close it!

Coachrobmd :

click on the fourth or fifth smiley face. That should do it.

Coachrobmd :

give that a try.

Coachrobmd, Internal Medicine MD
Category: Medical
Satisfied Customers: 1785
Experience: •Fmr. Dir. Hep. C Clinic. •Fmr. Dir. Head Trauma Rehab Ctr.
Coachrobmd and 4 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
why is it sometimes i get the pain and other times i dont? and why is the pain feeling worse. left sided pain is concerning and im getting a bit worried. seeing doctor later but is this just Costocondritis. the pain at times is severe but most of time dont notice it and not tender to touch.
Customer: replied 2 years ago.
Relist: Answer came too late.
Expert:  Dr. Phil, MD replied 2 years ago.
Answers are for informational purposes only.

Do you still need help?
Customer: replied 2 years ago.
yes
Expert:  Dr. Phil, MD replied 2 years ago.
What questions remain for you?
Customer: replied 2 years ago.
got a tingly feeling at back around area getting pain, severe pain when i move into new position but doesnt always happen? why is this and is this just costocondritis or could it be something else. i would expect a muscle injury etc to start getting better not worse and i dont understand why it has gone from being a small feeling to worse and worse...
Expert:  Dr. Phil, MD replied 2 years ago.

I reviewed your chat with Dr. Rob.

 

He gave great advice.

 

Your question seems to be that you are concerned that you are having this tingly sensation now and why isn't it improving after a couple days.

 

I have one final question before I answer.

 

Did you do any new activity that could have potentially caused a muscle injury?

Customer: replied 2 years ago.
yes to the first question and no to the last one. i first noticed it sitting down at work in the morning. hadnt done anything physically exerting that day or day before. this was a monday - hardly noticed anything for next few days but occassionally felt a twinge and then this weekend bingo - it hurts intensely for a few seconds (15-30 seconds) when move. And now have a tingly feeling in back and at front that seems to last quite a while.
Expert:  Dr. Phil, MD replied 2 years ago.

Okay.

 

Basically what is happening here is (and I agree with Dr. Rob), is that you have a pulled muscle or costochondritis.

 

What occurs is that muscles spasm in response to pain. So your injury caused a muscle spasm which causes more pain which causes more spasm....and it is a vicious cycle.

 

These muscle spasms also pinch on nerves and this is that tingly feeling you are having.

 

This one sounds severe because its not improving at all.

 

One of the best treatments is a muscle relaxer like flexeril. These are prescription though and your doctor can give you a script for them.

 

I would get in and try to get one of these today.

 

However, I am quite sure its just muscle/nerve related.

 

Please don't click "expected more" or "helped a little" as this leaves me negative feedback. If you aren't 100% satisfied, just click "continue conversation."

 

 

 

Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42317
Experience: Medical Doctor Trained at a Top Academic Institution
Dr. Phil, MD and 4 other Medical Specialists are ready to help you

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