left rib aera pain under left armpit and swelling down left side of adboment

[pj1963]

Hello, I have Crohns and 6 weeks agao had a bowel blockage, caused serve pain just to the left of the navel across to under left armpit, rib area. This had been going on and off for at least 6 mths.Had ct, colocscopy of done and a barrum meal follow through. Although still waiting on results of barrum meal test as it was only yesterday. Theory is Blockage was caused by inflammation from active Crohns where my small bowel was rejoined, a medical term starting with A they called it.
My gastro and surgeon do not know what to make of rib pain and what to do about it, I do see a sports medico who has treated me for synovtitis (inlfam arthrtis) of the hips. and he did some nuclear bone scans and plain file x-rays of the ribs and hip. Still no reason showing up, he got me to see a massurer (chrio) for her to try and release the inflammation between ribs. One sesson with her and a hernia appear that evening, a insurgical hernia my surgen called it. Now unless barrum mlea test shows something, I am at a loss why rib area is so bad particularly after eating. And I am concerned about getting anymore massage down in that area.
When it flares up it feels like my whole left side of torso from shoulder to hip is stiff and inflammed.
I am on antibotics and 25mg of steriods for Bowel problem.

Any advice you can give me would be very welcomed. I am starting to feel doctors here are at a loss or do not want to tell me, particularly my gastrolongist.

Thanks
Phil

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

You are describing rib pain with normal x-rays and bone scan.  The pain worsens after eating.

Although your description is not characteristic, obviously you have to make sure that the pain isn't related to your heart (i.e. angina, pericarditis, dissection etc.).  This can be evaluated with an EKG, appropriate imaging and stress testing.  

You want to exclude GI causes as well since the pain worsens after eating - this may be an atypical manifestation of dyspepsia.  An upper endoscopy to evaluate for peptic ulcer disease or gastritis may be considered.

Some kind of chest wall pain etiology should definitely be considered.  I will briefly describe a few:

Tietze's syndrome — Tietze's syndrome has been defined as a benign, painful, nonsuppurative localized swelling of the costosternal, sternoclavicular, or costochondral joints, most often involving the area of the second and third ribs.

Costosternal syndromes (costochondritis) — A majority of patients with musculoskeletal chest wall syndromes have a more diffuse pain syndrome, in which multiple areas of tenderness are found that reproduce the described pain.

Sternalis syndrome — The sternalis syndrome is a rarely described condition in which localized tenderness is found directly over the body of the sternum or overlying sternalis muscle, and palpation often causes radiation of pain bilaterally.

Lower rib pain syndromes — A variety of names have been given to pain syndromes involving the lower ribs, including rib-tip syndrome, slipping rib, twelfth rib, and clicking rib. This condition is characterized by pain in the lower chest or upper abdomen, a tender spot on the costal margin, and reproduction of the pain by pressing on the spot.

Ankylosing spondylitis — Pain in the thoracic spine and around the chest wall, resulting from inflammatory disease of the costovertebral, costotransverse, and thoracic apophyseal joints, is common in ankylosing spondylitis.

Fibromyalgia — Fibromyalgia is a common chronic musculoskeletal pain syndrome, characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance and multiple periarticular tender points found on physical examination.

You may want to discuss with your personal physician evalaution of these possible causes.  A rheumatology consult would be reasonable.

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:
1) Wise.  Major causes of musculoskeletal chest pain.  UptoDate, 2002.

[pj1963]

I meant to add, I also suffer from a chronic golden staph sinus condition mainly in my left sinus.
Chronic inflammation of the sinus membrame that surgery did not help.

thanks

[pj1963]

Thanks for reply.

[rossie4eva]

A related discussion, pain was started.