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Suggest Treatment For Pain In Right Upper Back
Question: Hello, I am XXXX,
Age: 55
Gender: male
weight: 60 kg
tall:165 cm
Social background: retired paramedic 28 years in the field 12 hours shifts 5 days a week, heavy smoker for 30 years, married. I sleep on relatively rigid bed on my right side for my whole life.
medical history: hepatitis in late 20s, it wasn't treated properly back then, but the inflammation gradually relieved on its own, I didn't attempt to do anything about it since back then other than following strict diet.
Current Complain:
In the last three months I have been feeling a slowly increasing pain in my upper right back, exact region mid and inferior of scapula.
Pain description: pain is not extreme but discomforting, increases with movement, and it gets relatively unbearable after physical effort by hours (without analgesic drug). It also increases after I drink cold fluids. When the pain reaches it peak it the affects breathing (both inspiration and expiration) and It radiates to my lower right back, and right arm.
Physical finding: minor edema around the region. no tenderness or abnormal skin colour.
Medication: I use Acetaminophen and Paracetamol alternatively; self-prescription.
Note: I do not like going to hospitals, nor I have enough time to it, so unless necessary I prefer not to be asked any kind of test.
I hope I can get help here.
Age: 55
Gender: male
weight: 60 kg
tall:165 cm
Social background: retired paramedic 28 years in the field 12 hours shifts 5 days a week, heavy smoker for 30 years, married. I sleep on relatively rigid bed on my right side for my whole life.
medical history: hepatitis in late 20s, it wasn't treated properly back then, but the inflammation gradually relieved on its own, I didn't attempt to do anything about it since back then other than following strict diet.
Current Complain:
In the last three months I have been feeling a slowly increasing pain in my upper right back, exact region mid and inferior of scapula.
Pain description: pain is not extreme but discomforting, increases with movement, and it gets relatively unbearable after physical effort by hours (without analgesic drug). It also increases after I drink cold fluids. When the pain reaches it peak it the affects breathing (both inspiration and expiration) and It radiates to my lower right back, and right arm.
Physical finding: minor edema around the region. no tenderness or abnormal skin colour.
Medication: I use Acetaminophen and Paracetamol alternatively; self-prescription.
Note: I do not like going to hospitals, nor I have enough time to it, so unless necessary I prefer not to be asked any kind of test.
I hope I can get help here.
Brief Answer:
It could be muscle spasm in the Dorsal Spine or problem with Oesophagus.
Detailed Answer:
Hello,
Welcome to Health Care Magic.
Thanks for your question and for the detailed description of the problem you face.
It really helps us to understand it better.
The pain you mention could be due to many causes. The commonest would be Muscle strains and sprains specially of the thoracic spine. Second would be any problem in the Oesophagus or Aorta or heart. The location of the pain is such that it is difficult to rule out any of these structures without relevant investigations.
I am presuming you are not on any regular medication for any diseases.
I suggest you get the following investigations done. A Chest XRay(will clear about Aortic and lung abnormalities), ECG(any heart lesions) and Upper GI Endoscopy(very important to rule out an oesophageal growth). Adding an Ultrasound abdomen would help us know the status of your liver, since you have had an episode of Hepatitis. You should tell them to look at your Aorta as well. Please let me know the reports of these and we can then decide what course of treatment to begin with.
You can continue with the Paracetamol that you were having whenever the pain gets unbearable or too much. That would be fine.
I would wait for the investigation reports and would advice you to change your posture till then. Sleep in opposite position and practice some Spine extension exercises. This can be learnt either online or from your Physiotherapist or Doctor. They are fairly simple and help a lot with spinal problems.
Take care and do let me know if there are any other queries.
Dr Rishi, New XXXXXXX XXXXXXX
It could be muscle spasm in the Dorsal Spine or problem with Oesophagus.
Detailed Answer:
Hello,
Welcome to Health Care Magic.
Thanks for your question and for the detailed description of the problem you face.
It really helps us to understand it better.
The pain you mention could be due to many causes. The commonest would be Muscle strains and sprains specially of the thoracic spine. Second would be any problem in the Oesophagus or Aorta or heart. The location of the pain is such that it is difficult to rule out any of these structures without relevant investigations.
I am presuming you are not on any regular medication for any diseases.
I suggest you get the following investigations done. A Chest XRay(will clear about Aortic and lung abnormalities), ECG(any heart lesions) and Upper GI Endoscopy(very important to rule out an oesophageal growth). Adding an Ultrasound abdomen would help us know the status of your liver, since you have had an episode of Hepatitis. You should tell them to look at your Aorta as well. Please let me know the reports of these and we can then decide what course of treatment to begin with.
You can continue with the Paracetamol that you were having whenever the pain gets unbearable or too much. That would be fine.
I would wait for the investigation reports and would advice you to change your posture till then. Sleep in opposite position and practice some Spine extension exercises. This can be learnt either online or from your Physiotherapist or Doctor. They are fairly simple and help a lot with spinal problems.
Take care and do let me know if there are any other queries.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello,
Thanks a lot Dr. XXXXXXX for the detailed, clear and informative answer.
Your presumption is correct, I am not on any medication other than I mentioned (for the pain).
If the most possible cause is muscle strains and the damage is already done (3 months since pain started), wouldn't it be too late for an intervention ?
Regarding the investigations you asked, I have done PA chest X-ray, high quality image is attached. Also, I have done 12 leads ECG/ECG. The facility I went for have kind of old ECG monitor, so it may shows some artifacts but it still readable. I asked them to do it again two times, three ECG strips is attached, if one of them had misleading artifacts please proceed to the next one (3rd strip is the clearest). I had no time to go for a larger facility for upper GI Endoscopy, nor the Ultrasound.
Unless you have already came up with the diagnosis, I would like to know what are the remaining possibilities, and their possible prognosis.
I have followed what you have advised regarding medication, sleeping and exercises.
Thanks again and looking for your answer.
Thanks a lot Dr. XXXXXXX for the detailed, clear and informative answer.
Your presumption is correct, I am not on any medication other than I mentioned (for the pain).
If the most possible cause is muscle strains and the damage is already done (3 months since pain started), wouldn't it be too late for an intervention ?
Regarding the investigations you asked, I have done PA chest X-ray, high quality image is attached. Also, I have done 12 leads ECG/ECG. The facility I went for have kind of old ECG monitor, so it may shows some artifacts but it still readable. I asked them to do it again two times, three ECG strips is attached, if one of them had misleading artifacts please proceed to the next one (3rd strip is the clearest). I had no time to go for a larger facility for upper GI Endoscopy, nor the Ultrasound.
Unless you have already came up with the diagnosis, I would like to know what are the remaining possibilities, and their possible prognosis.
I have followed what you have advised regarding medication, sleeping and exercises.
Thanks again and looking for your answer.
Brief Answer:
Your reports arre fine. Please get Endoscopy done.
Detailed Answer:
Hello.
Thanks for your answer.
I have seen the XRays and ECG. They are appearing fine. Even the Aorta appears fine in the Xray.
It could still be mucle spasm or injury. If it is that then it would be in the healing stage. The worry is only the possibility of Oesophageal problems. I suggest you get an Upper GI Endoscopy done to rule that out. Its not an emergency but get it done subsequently.
You are right about intervention for muscle injury as it is few months old. I am also not planning for any intervention for muscle injury. But before reaching a diagnosis of muscle injury we would need to rule out oesophageal issue.
Do not worry. Continue the same management and let me know the Endoscopy report whenever you can.
Take care and look forward to hearing from you.
Dr Rishi, New XXXXXXX XXXXXXX
Your reports arre fine. Please get Endoscopy done.
Detailed Answer:
Hello.
Thanks for your answer.
I have seen the XRays and ECG. They are appearing fine. Even the Aorta appears fine in the Xray.
It could still be mucle spasm or injury. If it is that then it would be in the healing stage. The worry is only the possibility of Oesophageal problems. I suggest you get an Upper GI Endoscopy done to rule that out. Its not an emergency but get it done subsequently.
You are right about intervention for muscle injury as it is few months old. I am also not planning for any intervention for muscle injury. But before reaching a diagnosis of muscle injury we would need to rule out oesophageal issue.
Do not worry. Continue the same management and let me know the Endoscopy report whenever you can.
Take care and look forward to hearing from you.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
Thanks for the reassuring answer.
In case it is a muscle injury, and it is too late for intervention, what would be the prognosis ? muscle fibrosis ?
Regarding the GI endoscopy, I am not in a city with qualified health care providers, so I am afraid that they may cause some complications after the procedure. Is there are less invasive procedures or tests such ultrasound ?. Also, in case of esophageal growth, wouldn't I encounter some difficulties swallowing, or I feel some discomfort while food passing my esophagus ?
thanks again, and waiting for your answer.
Thanks for the reassuring answer.
In case it is a muscle injury, and it is too late for intervention, what would be the prognosis ? muscle fibrosis ?
Regarding the GI endoscopy, I am not in a city with qualified health care providers, so I am afraid that they may cause some complications after the procedure. Is there are less invasive procedures or tests such ultrasound ?. Also, in case of esophageal growth, wouldn't I encounter some difficulties swallowing, or I feel some discomfort while food passing my esophagus ?
thanks again, and waiting for your answer.
Brief Answer:
Do get an Ultrasound then. Do not worry about a muscle injury.
Detailed Answer:
Hello,
Good to hear from you.
If it was a muscle injury, it would heal naturally and would not lead to any long term problems and the pain will also subside once healing is complete. There is no need to worry about that at all.
Do get an Ultrasound abdomen done as it is not an invasive procedure. Try and get an Endoscopy done at a better Center with good experience in the procedure. But there is no less invasive investigation to rule out an oesophageal pathology. Oesophageal lesions or growth present with difficulty/ discomfort in swallowing solids or liquids or both called Dysphagia. Pain is usually not a feature until there is acid reflux or advanced cases.
Take care and do let me know if there are other queries.
Dr Rishi, New XXXXXXX XXXXXXX
Do get an Ultrasound then. Do not worry about a muscle injury.
Detailed Answer:
Hello,
Good to hear from you.
If it was a muscle injury, it would heal naturally and would not lead to any long term problems and the pain will also subside once healing is complete. There is no need to worry about that at all.
Do get an Ultrasound abdomen done as it is not an invasive procedure. Try and get an Endoscopy done at a better Center with good experience in the procedure. But there is no less invasive investigation to rule out an oesophageal pathology. Oesophageal lesions or growth present with difficulty/ discomfort in swallowing solids or liquids or both called Dysphagia. Pain is usually not a feature until there is acid reflux or advanced cases.
Take care and do let me know if there are other queries.
Dr Rishi, New XXXXXXX XXXXXXX
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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