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My son is 19 and has chronic pain on the right side of his…

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My son is 19 and...
My son is 19 and has chronic pain on the right side of his chest, about 2 inches below the collarbone. On xray it showed a congenital articulation of the 1st and 2nd rib. As a kid, he always had discomfort in that area, but over the last year, the pain has increased and is constant. Sometimes a dull ache and sometimes a stabbing pain that lasts a few seconds to a few hours. Have been to several MD's and no one can diagnose what is causing the pain. No known trauma. Any advice would be helpful. Thanks!
They have ruled out: costochondritis, TOS,
MRI normal except for rib abnormality.
Submitted: 8 years ago.Category: Medical
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Answered in 14 minutes by:
6/28/2010
Doctor: Dr.tiwari, Doctor replied 8 years ago
Dr.tiwari
Dr.tiwari, Doctor
Category: Medical
Satisfied Customers: 5,256
Experience: M.D.
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Chat Conversation Started
Dr.tiwari :

Hello,

Dr.tiwari :

Is there any reflux symptosm?

Is he has chronic cough?

Dr.tiwari :

Is hr taking any medicines?

Dr.tiwari :

Please reply.

Customer:

No reflux or cough. Takes effexor, was on neurontin for a while. Takes Klonopin for anxiety

Dr.tiwari :

Any upper back pain?

Dr.tiwari :

Abnormal posture?

Dr.tiwari :

Thanks for information.

Customer:

Pain radiates to back. Has bad posture from guarding his chest for so long

Dr.tiwari :

In absence of any MRI finding,injury,fever & other chronic disease with radiation of pain to back ,this may be most probably due to either compression of the nerve in upper back & chronic stress leading to muscle pull or strain at the inner side of the chest by excessively active intercostal muscles.

Dr.tiwari :

Except the routine anti inflammatory analgesic he may get relief by taking some nerve analgesic like pregabalin,gabapentin or a combination of tramadol with paracetamol (ultracet),

Dr.tiwari :

You may also ask your doctor for local steroid injection in case if this problem is of long duration.

Dr.tiwari :

Hope this will help you.

Dr.tiwari :

If you have any other query then let me know.

Customer:

I have been advised to take him to a cardiothoracic surgeon for evaluation, because it is chest wall pain. They won't do a steriod inj because its too close to the lung.

Dr.tiwari :

In safe hands & under CT/USG GUIDE it will not affect the lung.

Dr.tiwari :

If there is not other symptoms like cynosis or ecxcessive fatigue or breathlessness then cardiothoracic reason is most unlikely.

Customer:

Sorry, not satisfied with the answer.

Dr.tiwari :

What is unsatisfying you?

Dr.tiwari :

The burning pain is not a symptom of the herat related pains.The cardiothoracis reasons are related with either lung or heart which should either show symptoms related with them like breathlessness or blueness of the extremities or palpitation without other known reasons,etc.

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Doctor: Dr.tiwari, Doctor replied 8 years ago
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Doctor: The Physician, Doctor replied 8 years ago
The Physician
Category: Medical
Satisfied Customers: 1,160
Experience: Versatile Emergency Physician, 20 years experience as a Physician.
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Greetings

In the womb, during the embryological development of the chest wall, the bones, the muscles and the neurovascular bundle follow a pattern that is set in the genes and made active by cell migration. The pattern is so choreographed by nature that when one goes wrong, there is a likelihood that subsequent patterns are most likely to be altered.

In the Chest, the wall is formed, before the lung bud grows to fill the space.

If there is s congenital fusion of the 1st and 2nd rib, that forms the apical area of the chest wall.

The following are likely

The malformation of the neurovascular bundle that supply the intercostal muscles, leading to muscular spasms of the 1st intercostal muscles from ischaemia etc and perhaps neuropathy involving the area.

The Brachiocephalic artery, divides in underneath the 1st rib to the common carotid and right subclavian arteries. It is vulnerable due to this aberration

There could also be a mechanical pull on the bones during inspiration effort (because of the imbalance from the opposite side), especially in an actively growing young man.

I agree,

A cardiothoracic(not a cardiovascular) surgeon needs to evaluate him with all these in mind. After assesment, they have to cosider the possiblity of freeing the ribs, and checking for trapped nerves etc

If you, can get two opinions.

This type of pain would ONLy respond to a mild narcotic(however they have to be careful with dose, to avoid addiction), because it is NOT inflammatory. THIS again need to be evaluated by a pain expert in a pain clinic. ON CHOICE OF MED.DO NOT TAKE MY ADVICE or ANY Internet advice on this ( any wrong pain tab might get him addicted and create another problem)

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