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Pain in upper right chest under collar bone and shoulders, radiates to arms, legs. Diagnosed costochondritis. Next treatment line ?

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Hi, I am a 24 year old male with a recent history(2years) of pain on the right lower side of my ribs and chest pain usually upper right chest pain under the collar bone and in the back between my shoulder blade that feels kind of hot and radiates to my right arm and leg, I also suffer of really bad gas episodes especially after meals. i suspected gallbladder issues since my mom has suffered of similar symptoms and has had hers removed. I have had numerous tests done including:ultrasounds, countless blood tests urine tests, ekgs, catscans and X-rays according to doctors everything appears normal and have been diagnosed with: costochondritis, floating rib pain, muscle pains, tmj, gastritis?? I am so confused and i am loosing hope. My symptoms have really interfered with work, my social life I would really appreciate constructive feed back to help determine my next course of action
Posted Tue, 22 May 2012 in Bones, Muscles and Joints
Answered by Dr. Shainaz Arif Kaware 4 hours later


Thanks for your query.

The symptoms you describe are similar to gall bladder pathology and I am glad that you have been investigated thoroughly and all the tests including ultrasound have ruled it out.

Considering the gall bladder is normal on the tests, what I infer after reading your query is that the pain in ribs on right lower side can be due to gastritis and the upper pain may be costochondritis or a muscular pain. As the pain has been quite often and been there since last 2 years, I guess the pain is making you anxious and you are getting stressed. Further Florastor which is a probiotic type of medicine and contains healthy bacteria can cause constipation and gas.

I would suggest you try some proton pump inhibitors like omeprazole (Prilosec OTC) once a day before food for 2-3 weeks. Domperidone that helps in quick emptying of stomach can also be beneficial. Both these drugs are available as over the counter medication at some places.

Anxiety and stress also needs to be managed as they are interfering with your daily life; so here are few things which will help you:-
- Remember you are 24 yrs and you will not easily get any major disease so if you have any thoughts please leave them behind,
- Try to concentrate on your work as it will help you keep your mind away from thoughts of disease,
- Try to relax if there is stress in your life - transcendental meditation, yoga, XXXXXXX breathing exercise, mild to moderate physical exercise can be helpful in reducing the effects of stress.
- Also avoid smoking or drinking if you have any of the habit,
- Do regular exercise as it will tone up your body as well as reduce stress levels.

You can also consider visiting your doctor to control stress with prescription medication. Discuss with your doctor regarding the benefit medications I have advised and get the proper dosage prescribed.

Hope this answer is helpful to you. Let me know if I have missed out on any of your concern.

Take care and Regards
Above answer was peer-reviewed by
Follow-up: Pain in upper right chest under collar bone and shoulders, radiates to arms, legs. Diagnosed costochondritis. Next treatment line ? 20 hours later
Dr. What would you recommend for the chest pain? when it becomes intense I end up in the ER with the fear that it may be cardiac related but all tests end up negative. (this has happened several times)

How can I treat this ? Also what is your knowledge regarding floating rib pain this doesn't seem like an accurate diagnosis to me. (gastro said it was floating ribs)

Thanks for your input doc.
Answered by Dr. Shainaz Arif Kaware 3 hours later

Thanks for writing back.

The first thing is you get severe chest pain on right side where as the heart is on the left side.

Cardiac pain (pain related to heart) is more of a squeezing, suffocating type of pain.

This pain is due to reduction in oxygen supply to the heart muscles.

It will be seen in ECG (Electrocardiogram), also it will not come frequently without complicating.

For treatment I would suggest you to get medicine for stress prescribed by your doctor. Get started on medicine for gastritis as I have suggested and hopefully you should be fine.

When the pain is severe you may take an over the counter medicine like Tylenol.
Lastly the 11th and 12th ribs are known as floating ribs (costae fluitantes) as they do not have any anterior connection to the sternum and are attached to only to the vertebras.

Hope I have answered your concern.

Wishing you good health.

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