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Weird mystery pain in my scapula/back and ribs

Any thoughts or input on this problem would be appreciated.

About 3 or 4 years ago I developed a pain in my back in the region of my lower scapula. I was sitting at the time, but was tense because it was cold, so I thought it was a muscle cramp. The next day, it hadn't let up so I thought the muscle cramp tore the muscle and that it just needed time to heal. After taking it easy for a few weeks, the pain dissipated and I went back to my normal activity level, which is nothing exciting but involves some light core body exercises such as plank. Upon returning to my normal activity level, the pain reoccurred and has been on again off again for the past few years and expressing in the following strange manner.

1. Comes on spontaneously or two days after certain exercises or activities such as plank, side plank, carrying even a light load on my shoulder on the opposing side, or sitting up in bed leaning against my pillow.

2. Pain originates from the lower scapula but often spreads or migrates down along my ribs in my back, typically around the lower ones but sometimes around the one under my armpit. Sometimes I will have pain in the lower ribs but not the scapula and sometimes the scapula but not the ribs, but typically pain in both. It does not spread to my sternum.

3. Very occasionally when the pain is very bad it will spread upward in to my arm, and travel down the nerve, but from the underside of my arm, not the outside of my arm.

4. The pain gets worse when first start walking and becomes very severe before peaking but will resolve if I continue and my reoccur sometime later that day. The pain may come and go in as little as a moment. In one instance it resolved when I bent down but I have not been able to reproduce this or any other movements that have previously resolved it...it seems random.

5. Pain ranges from a mild aching to a pinching to a severe stabbing....a lot of times I feel like I have an arrow lodged in my back.

6. The pain does not reach my sternum so it's not costochondritis.

7. It does not limit my range of motion or worsen with motion.

8. The ribs in my back on that side pop easier when pressed than on the other side.


Clinical examination findings:

1. I have thoracic kyphosis (I have had this since childhood).
2. I have scapular dyskinesis, (but my pain is not consistent with the pain typically seen with this condition)
3. I have previously injured my thoracic spine, but spinal MRI was negative.
4. X-Ray of scapula/shoulder was negative.

I've seen two spine specialist, a sports medicine orthopedist and a general orthopedist but have been given no definitive cause for the pain. I have been referred to a neurologist in hopes of finding out which nerve is involved but I will likely not be able to see him for six months.


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