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Dr. Abby
Dr. Abby, US Board Certified MD
Category: Medical
Satisfied Customers: 10330
Experience:  Family Physician practicing medicine for over 10 years, United States
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I have a pain at the bottom of my left rib-cage. I feel the

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I have a pain at the bottom of my left rib-cage. I feel the pain when I move or turn in certain positions. I can touch the precise area. I did an ECG, and the cardiologist thinks it is muscular. I did an ultrsound of the abdomen, which was normal. I did a chest x-ray which was normal. The doctor thinks it is a muscular strain and has started me on Naprosyn 500mg and a strong pain killer. What do you think?

Do you have other concerns as to what it may be specifically?

Dr Abby
Customer: replied 7 years ago.
My main concern is to be absolutely sure that the diagnosis is right, and that I don't need any further tests.
Where exactly is the pain?
Is it on the lower left side, over a rib?
Customer: replied 7 years ago.
It is on the lower left side, and i feel it when I press the last rib. Close to the abdomen.
It sounds like the doctor has assessed correctly in that it is musculoskeletal.
Not much is in that area but bone, muscle.
Below that area is the stomach--but the rib would not be tender itself if you had problems with the stomach. Ulcers and pancreatitis would present with abdominal pain, nausea, vomiting, weight loss. Pain would likely be worse after eating, not related to positioning/movement.

The chest xray is pretty good for looking at ribs, you may want to have your doctor do specific rib xray to assess the actual rib area that you are having pain. If it doesn't get better and the pain is specifically on the rib itself, you could have a bone scan done. This will tell if there are any abnormal spots on the rib (small hairline fracture, tumors, etc) causing your pain.

Reproducible lower chest wall pain is likely muscular or bony. Nothing else is in that area.
Chest xray ruled out lung pathology.
Only other thing to do would be blood work to look at pancreas enzymes but again, nothing in your symptoms suggest abdominal problems.
If you have more questions or more to add, let me know, I would be happy to discuss.
Dr Abby
Customer: replied 7 years ago.

You indicated that if the pain does't get better, a bone scan would be advisable as a means of ascertaining whether there's a fracture or even a tumor? How can one be sure at this stage that it is not a tumor?!

Well, it is very rare.
There is no way to tell for sure at this stage.
Depending on the location of the pain, something may have shown on the chest xray, as we can see the ribs. It depends on where the pain is and whether that area was adequately seen.

You can ask your doctor if that area was adequately evaluated by the chest film. If not, he can order rib xrays as a place to start.
That will show rib fracture and should show tumors as well.
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