Pain ir rt. shoulder and rt. side under ribs

Hi,
I had my gall bladder removed on 1/7/03 (no stones) which did not take care of my middle chest pain.  I then had a motility test of my esophagus on 2/10 and I was diagnosed with nutcracker esophagus and given nitroglycerin which relieves my middle chest pain.  But, on 2/9, the day before my motility test, I awoke to severe right chest pain which then radiated to my right shoulder blade.  I told my doctor before the motility test and he didn't seem to want to hear it, he just wanted to get the test done.  Over the last 2 weeks, I have had pain that feels like a stitch in my side under my right rib,  an aching and a twinging feeling in my right shoulder blade, and an itermittent sharp chest pain that will shoot across my right chest. It seems that when I am having a chest pain it also hurts under my ribs, but sometimes it hurts under my ribs without the chest pain, and when my shoulder blade is aching-I don't seem to have the pain under my ribs.  Sometimes it seems to hurt more after I eat. I know it is confusing.  It is kind of getting me down.  I thought that my problem was solved with the diagnosis of nutcracker esoph., only to have this new pain arise.  I am feeling pain in one of the three places mentioned above at sometime all during the day and night.  Could it be some reaction or complication from my gall bladder surgery?  I had a total heart work up 1 1/2 years ago and all was normal.  I am a 35yr old otherwise healthy female, and the only meds I take are asiphex and premarin.   Thanks

[Kevin Pho, MD]

Hello - thanks for asking your question.

As you know, there are a multitude of things that can cause chest pain - moreso than GI or cardiac causes.

Here is a brief list you may want to discuss with your personal physician.

Non-ischemic CV:
Pericarditis

Pulmonary:
Pneumothorax
Pleuritis
Pulmonary Embolus

GI:
Esophageal spasm, reflux, esophagitis
Biliary colic, cholecystitis, cholangitis
Peptic ulcer
Pancreatitis

Chest Wall:
Costochondritis
Fibrositis
Sternoclavicular arthiritis
Zoster

If the heart workup was normal, and food exacerbates the pain, perhaps an upper endoscopy would be in order to evaluate for gastritis, esophagitis, or peptic ulcer.

If this has already been done, perhaps further diagnostic tests to evaluate the causes above should be discussed.

I strongly suggest following up with your personal physician.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[mainebound2014]

Correction to my original post.  I was reading through it and it is my left shoulder, left chest, and under left rib.  Not right.  I must have had my head in the clouds when I wrote the original post.  Sorry!

[pgerman]

You are not alone.  Same problem here.  Nauseous almost all day every day for the past 5 weeks.  Pain under left breastbone or left shoulderblade.  If not there, then under right ribs and right shoulderblade.  After I eat, approximately 1-3 hours later extreme pain--sometimes feels like it is boring straight through to the back.  With extreme pain, start to heave, but haven't vomited yet.  Doesn't seem to matter what I eat.  When I don't eat pain not as intense, but the ache is almost always there--one of the shoulder blades; usually left or right upper abdomen.  Occasionally happens on empty stomach--will get nauseous and start to heave.  Not much of an appetite.  Epigrastic area tender.  

Had chronic cholecystitis that started in March 2002.  Took approximately 6 months to determine gallbladder problem. Symptomos were not consistent.   First HIDA scan in August 2002 normal.  Second one in September 2002, gallbladder did not visualize at all.  Gallbladder out 10/2002--no stones--just evidence of chronic inflammation.  Had trouble holding down soup.  Had several attacks each week until gallbladder out.  Had endoscopy in September to rule out any other problem.  Everything normal.    

Felt great from the time gallbladder out until the problem started again mid-January 2003.  Feels very similar to the  gallbladder attacks.  Have had 5 severe attacks since mid January.  My gastro doc is just starting to run tests.  Tried Nexium--didn't help and often made it worse.  (Sigh.)  Doc says could be bile reflux, missed stone, SOD or sludge.  It is starting to wear me down. (Heavy sigh.)  Liver test normal.  Had an MRI last Friday; waiting for results.  

I have lost approximately 28 pounds September 2002.  Not complaining about that though, since I am trying to lose weight but didn't want to do it this way.

I don't want anyone to suffer but it does offer some comfort to know that I am not alone.

[surgeon]

You should also consider being in touch with your surgeon. It's close enough to the surgery that it's not impossible that your symtoms (symptoms) have to due with it. A remote possibility is a small leakage of bile. It's easy to check.