Expert: Dr. Nekessa Remy - 11/8/2009

Question
QUESTION: Hello,

I have been experiencing pain in my  right pectoral muscle for approximately 3 or so months now. I cannot remember having an event where I strained the area through use. The pain I expereince intitally was constant for approx 2 months, and now I have episodes where the pain will go for 5 days and I may have 2 or so days of no pain at all. I only have some relief by applying topical non steroid anti inflammotory gels and some times the pain is so severe I have to take panadeine (paracetamol/codene based). The pain ranges from a contstant ache, sometimes a burning sensation. The muscle is tender to touch especially where it meets my upper chest. I have also pain radiating to my breast (I have had an ultrasound to rule out breast diseases) and I especially have a burning sensation in my axilla. I am due to have an ultrasound scan this week to my shoulder/pectoral area, possibly to rule out abcess stc. There is no redness or bruising or any pathology observed on the skin. I have tried mild exercises of stretching when on the days of no pain at all, but I find it only brings on the pain a couple of hours later. I had a couple of incidences of tingling in my fingers of right arm, but not for 5 weeks now. I feel a weakness in my arm now at the pectoral muscle area, especially when washing my hands - rubbing them together. I feel this is now affecting my mental healthe with the constant, life affecting pain as I am limited in what I can do. Stress has been a major part of my life in the last 6 months, however I am unsure if that is related?
Thank you for your time,
Niki

ANSWER: Hi Niki,

The ultrasound is a good idea to rule out any underlying shoulder or pectoral injuries. Have you had any massage or soft tissue therapy? There may be an active trigger point (or muscular adhesion) in the pectoral or shoulder region causing the pain in that area and refferal into the arm. it is difficult to give a diagnosis when I have not conducted a physical examination.  There are many organs which also refer pain into the axilla and pectoral region specifically the gall bladder. It can refer pain into the left shoulder region including the pectoral region. As for stress, well over 90% of the conditions I see in my office are affected by stress. After your ultrasound I would advise you visit your MD and ask for a gall bladder examination, usually that involves just blood work initially. I would also seek some type of relaxation therapy/treatment. Yoga, meditation, someone to talk too, these are all little things that can help you cope with your current condition.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply Dr.Remy.
I have since had the followup ultra sound of my right shoulder & no tears noted or lumps in pectoral/lymph nodes. I have started to try some (self) massage of the pectoral muscle (towards the heart) with relief of pain, especially when I feel the pain coming on. Would this indicate a positive treatment for trigger point therapy/massage?
In reference to the gall bladder refered pain, would this also be the case for RIGHT shoulder pain, or only indicated with Left?
I am looking at changing my MD as they do not know what else to do with the issue except injecting the area, with analgesics, which I do not want to do. I see this as a bandaid solution & not treating the issue.
Regards
Niki

Answer
Hey Niki,
I am glad to hear that the ultrasound was negative.  The relief you feel with massage is a good indication that there may be an active trigger point in that region. Massage therapy or Active Release Therapy may be beneficial for you. I would search your local yellow pages to find a health care provider. I apologize for my error, the gallbladder does refer pain into the RIGHT SHOULDER, not the left.  Your MD should be able to assess this. If not perhaps a naturopath may be good solution.

Keep me posted!
Dr. Remy