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Family Medicine (Expert Forum)
chest pain
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
chest pain
by macsmom, Sep 21, 2003 12:00AM
Hello, over one year ago, i began having severe chest pain in my upper left chest wall, below the collar bone above the breast, each time i would try to exend my left arm, i would pull it back in severe pain, I went to the er, had a ekg, drank some green liquid? was told i had inflammation in my chest and was prescribed motrin. I am 32 female, one child, 2yrs, Over a year later I still have the pain, although I can move my arm now. I have had and echocardiogram and rib x-ray. I quit my job at the time and did nothing for three months as the doctor suggested, nothing helped. i take bextra for pain managment, and cannot miss a day or the pain is intolerable. I am concerned that my doctor is missing something, I cannot do any of the physical activities that i used to do, lift weights, sports, sit ups, nothing. No other tests have been suggested, I just keep taking the medication, it seems that it would have cleared up by now. I also read that inflammation is a bigger factor than cholesterol in determining risk to the heart and am extremely concerned about this, my doctor doesent seemed concerned at all.
Doctor's Answer
by Kevin Pho, MD, Sep 22, 2003 12:00AM
, Sep 22, 2003 12:00AM
With the fact that the pain is worsened on arm movement, it suggests a musculoskeletal cause. You have had an echocardiogram and rib x-ray which were not revealing.
To be sure that the pain is not coming from your heart, you may want to obtain an exercise stress test to ensure that it is not the source of the pain.
You can consider obtaining an erythrocyte sedimentation rate (ESR) which is a relatively nonspecific test for inflammatory disease which is elevated in a majority of patients with infectious arthritis, active rheumatoid arthritis, ankylosing spondylitis, and other spondyloarthropathies.
A CT scan can be considered to provide visualization of the sternoclavicular and manubriosternal joints. Scintigraphy can also be considered to show increased uptake in involved areas in inflammatory syndromes, after trauma, or with tumors.
If all the tests are negative, you may want to consider a referral to a pain specialist where they can help increase your functionality in the setting of the pain.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Wise. Clinical evaluation of musculoskeletal chest pain. UptoDate, 2003.
To be sure that the pain is not coming from your heart, you may want to obtain an exercise stress test to ensure that it is not the source of the pain.
You can consider obtaining an erythrocyte sedimentation rate (ESR) which is a relatively nonspecific test for inflammatory disease which is elevated in a majority of patients with infectious arthritis, active rheumatoid arthritis, ankylosing spondylitis, and other spondyloarthropathies.
A CT scan can be considered to provide visualization of the sternoclavicular and manubriosternal joints. Scintigraphy can also be considered to show increased uptake in involved areas in inflammatory syndromes, after trauma, or with tumors.
If all the tests are negative, you may want to consider a referral to a pain specialist where they can help increase your functionality in the setting of the pain.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Wise. Clinical evaluation of musculoskeletal chest pain. UptoDate, 2003.
