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Family Medicine (Expert Forum)
chest wall pain/breastpain/leg 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 wall pain/breastpain/leg pain!
by brendastarshine, Feb 22, 2004 12:00AM
55 yr old female. Had a thoracotomy in 2000, for empyema (spelling?).lung was collapsed, chest and lung abcessed. I researched surgery,was concerned about post-thoractomy pain syndrome. The lung was cleaned out and & chest wall was scraped. After the surgery, incisional area side pain was fairly severe for a couple months, but relieved with vicodin and slowly reduced greatly to very mild 'discomfort' rather than real pain. I was just so relieved that I didnt have the severe pain I had read about that the mild pain that I have had since then, I've just accepted. The first year, it felt as though I had a concrete block in my side. I'll make a conflicting statement here and say that my side (between breast & waist) was numb 3 years -yet as it slowly un-numbed, has always been extremely tender! Side was totally numb for the entire first year,finally all numbness gone after 3 yrs.
Tenderness has increased lately, I sometimes hold 'in' my side when I walk.(like hernia!)
But, I cant twist far to the right, or bend well on the right side. The concern is that ever since surgery, on occasion when I twist far to the right (for instance on the toilet, to wipe) - I get a terrible, painful spasm-like charley-horse- that is intense, I must freeze until it relaxes and I can move or breathe again. Really rather scary. Happens if I get something out of the back seat of the car, or move suddenly to the right. Sometimes it lasts for a minute or more. Recently it happened when I was lying flat in bed and jerked my upper body upright trying to slide a pillow under my head - this time it happend almost in the center of abdomen ( instead of right side) and continued to re-spasm for several minutes, I couldnt move a muscle, very painful.
Recently all the pain issues became unbearable and I finally went to my internist.
I thought I have an incisional hernia, but a CAT scan only reveals 'a thickening' there. Dr. ordered chest x ray & referred me to pulmonary spec. for 'chest wall pain', but I cant get in for a month. Also,for about a year I have had gradually increasing leg pain/muscle weakness, sometimes unable to walk across a room, shop, etc. Calves mostly, but also butt and thighs. Relief as soon as I sit, although muscles remain tender.
Lower back pain ( butt area) too. MRI's & Doppler only reveal 'moderate atherosclerotic disease'. Am having a MRA this week. Spinal stenosis was ruled out.
In addition to all this, I have had twinges behind right breast ( same area as side pain) -intermittent. Took myself in for a mammogram in June, nothing showed up . Seeing Gyn. tomorrow.
Hoping its related to the side pain.
Please! your thoughts on: A) adhesions? B) precordial catch syndrome? C) could ALL these problems be related to an intracostal nerve being Pinched? Would that account for the 'strangulation' sensation I attributed to a hernia?? if so, treatment?
Any advice/thoughts/suggestions VERY appreciated.
Tenderness has increased lately, I sometimes hold 'in' my side when I walk.(like hernia!)
But, I cant twist far to the right, or bend well on the right side. The concern is that ever since surgery, on occasion when I twist far to the right (for instance on the toilet, to wipe) - I get a terrible, painful spasm-like charley-horse- that is intense, I must freeze until it relaxes and I can move or breathe again. Really rather scary. Happens if I get something out of the back seat of the car, or move suddenly to the right. Sometimes it lasts for a minute or more. Recently it happened when I was lying flat in bed and jerked my upper body upright trying to slide a pillow under my head - this time it happend almost in the center of abdomen ( instead of right side) and continued to re-spasm for several minutes, I couldnt move a muscle, very painful.
Recently all the pain issues became unbearable and I finally went to my internist.
I thought I have an incisional hernia, but a CAT scan only reveals 'a thickening' there. Dr. ordered chest x ray & referred me to pulmonary spec. for 'chest wall pain', but I cant get in for a month. Also,for about a year I have had gradually increasing leg pain/muscle weakness, sometimes unable to walk across a room, shop, etc. Calves mostly, but also butt and thighs. Relief as soon as I sit, although muscles remain tender.
Lower back pain ( butt area) too. MRI's & Doppler only reveal 'moderate atherosclerotic disease'. Am having a MRA this week. Spinal stenosis was ruled out.
In addition to all this, I have had twinges behind right breast ( same area as side pain) -intermittent. Took myself in for a mammogram in June, nothing showed up . Seeing Gyn. tomorrow.
Hoping its related to the side pain.
Please! your thoughts on: A) adhesions? B) precordial catch syndrome? C) could ALL these problems be related to an intracostal nerve being Pinched? Would that account for the 'strangulation' sensation I attributed to a hernia?? if so, treatment?
Any advice/thoughts/suggestions VERY appreciated.
Doctor's Answer
by Kevin Pho, MD, Feb 23, 2004 12:00AM
, Feb 23, 2004 12:00AM
I would first ensure that the pain isn't related to the procedure you had. It seems like this is being evaluated. If all the tests are negative, I would suggest a referral to a neurologist. Possible electrodiagnostic testing can be considered to evaluate if there is a nerve disorder causing your discomfort. A neurologist can be evaluate your muscle weakness as well.
Another possibility would be a referral to a rheumatologist. They can do further evaluation - such as tests for thyroid, rheumatoid arthritis, lupus, or myopathies - that may be causing your symptoms.
It is also possible that the diseases you mentioned in your question may be related to the symptoms. If everything is negative, then the focus should be on pain management. A physiatrist (rehabilitation specialist) can be considered to further consider this option.
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.
Another possibility would be a referral to a rheumatologist. They can do further evaluation - such as tests for thyroid, rheumatoid arthritis, lupus, or myopathies - that may be causing your symptoms.
It is also possible that the diseases you mentioned in your question may be related to the symptoms. If everything is negative, then the focus should be on pain management. A physiatrist (rehabilitation specialist) can be considered to further consider this option.
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.
