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I've been lurking here for a while trying to decide

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Posted on Fri, 22 Feb 2019
Question: I've been lurking here for a while trying to decide whether or not to ask, but I have another six days until I see my orthopedist and the anxiety is killing me so I thought I'd give it a shot!

Whenever I round my left shoulder and twist towards the right I get a burning, pinching pain in my sternum. It's often aggravated by me sleeping on my right side (as I tend to pull my left shoulder close to my ear while I sleep on my right side), and my left shoulder naturally sits a bit higher than my right. I can sometimes locate the exact spot where the pain originates, too, and it's quite tender when pushing on it.

The pain has been there for a few months off and on, but seems to get worse and stick around longer when I get obsessive about it and twist often to check if it's still there. I haven't had any acute injuries involving my chest wall, but I do have very rounded shoulders and poor posture, as well as herniated L4 and L5 discs.

Does this pain sound like costochondritis? I tend to be a very medically-anxious person, so waiting for my doctor's appointment is driving me bonkers!
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Costochondritis is well likely.

Detailed Answer:
Hello and welcome to HealthcareMagic!

Judging from your description it seems that you've identified yourself the most likely diagnosis. Given the location of the pain, the exacerbation from position changes and local tenderness, I would say that costochondritis is indeed the most likely cause.
Another possibility would include a pulled muscle which may also produce similar symptoms. In terms of management they do not differ much, both are benign issues which with exertion avoidance and over the counter anti-inflammatory medication gradually improve.

Often an electrocardiogram, chest X-ray and some routine blood tests for inflammation changes are done to exclude heart and lung disease as well as systemic rheumatological conditions but they should turn out normal, not a reason to wait anxiously.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (1 hour later)
Thank you so much for your response, I really appreciate it!

It's interesting, I only feel the pinching pain in that one position-- when I round my left shoulder and try to bring it towards the right-- and I definitely don't feel anything on the right side. I have a low resting heart rate (usually between 54-57 bpm), normal blood pressure, and have a regular annual check up with my GP, so is it likely this could be a heart issue? I am worried about that since it's localized to my left side.

As for where the pain is, when I press down with my fingers I feel it right around my 5th rib in one spot in particular, but when I do the rounded shoulder test it almost just feels like a very tight muscle that then pinches at the site on my rib, if that makes sense.
doctor
Answered by Dr. Olsi Taka (12 minutes later)
Brief Answer:
Heart issue highly unlikely

Detailed Answer:
Thank you for the additional information. I still believe costochondritis to be the most likely diagnosis, it is commonly exacerbated by specific postures or actions, most commonly affected ribs are from the 2nd to the 5th rib and it may be waxing and waning in nature like in your case. So if the tenderness is on the costochondral junction it remains the most likely diagnosis.

I don't think a heart issue is likely at all. Apart from the fact that you are a young individual, with apparently no risk factors, the description of the pain does not fit with a heart issue, a heart issue is not influenced by local pressure, is not tender upon touch, doesn't change with shoulder movements. So while as I said an EKG is often done routinely I don't expect it to show any heart related origin.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (11 minutes later)
Thank you, Dr. Taka! Is there anything I can do between now and my appointment to take care of myself better?
doctor
Answered by Dr. Olsi Taka (3 minutes later)
Brief Answer:
Read below.

Detailed Answer:
I wouldn't recommend major changes, simply avoid strenuous physical activities and try to relax. As I said it is not a threatening diagnosis, it is a benign, transitory and self limiting condition, so while naturally not desirable there is no reason to over-worry, anxiety is often a contributor in prolongation of the symptoms.

I hope you will feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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I've been lurking here for a while trying to decide

Brief Answer: Costochondritis is well likely. Detailed Answer: Hello and welcome to HealthcareMagic! Judging from your description it seems that you've identified yourself the most likely diagnosis. Given the location of the pain, the exacerbation from position changes and local tenderness, I would say that costochondritis is indeed the most likely cause. Another possibility would include a pulled muscle which may also produce similar symptoms. In terms of management they do not differ much, both are benign issues which with exertion avoidance and over the counter anti-inflammatory medication gradually improve. Often an electrocardiogram, chest X-ray and some routine blood tests for inflammation changes are done to exclude heart and lung disease as well as systemic rheumatological conditions but they should turn out normal, not a reason to wait anxiously. I remain at your disposal for other questions.