Expert: Gerald Anzalone, D.C. - 1/23/2012

Question
Hello, thank you for taking the time to read my story.

A year ago after a period of increased activity (my son broke his leg and I was lifting his wheelchair in and out of car and I shovelled lots of snow off drive) I felt a pain in my left pec muscle when pressure was applied. Shrortly after this I was having painful muscle spasms every now and again in the same area for a month. I then eas carrying a heavy bag on my left should that kept falling on to my arm the spasms were more painful and frequent and two days later I experienced a feeling of heat and excruciating pain with swelling where armpit becomes my chest. I have been left with a constant dull ache getting worse with activity and relieved somewhat with rest. The pain feels as if it is in/between my 4 th and 5 th rib. I have had a mammogram ( normal) chest X-ray  (normal) and an echocardiogram ( normal) . Have you any idea what this injury coul be? Thanking you in advance"

Answer
Karen,

I can't provide you with a diagnosis over the Internet, but in general, your symptoms suggest a soft tissue injury, and possibly a torn muscle. An MRI should have been performed to rule this out. In the presence of continued pain and symptoms, an MRI of the upper chest is indicated, or possibly an MRI of the shoulder to rule out a rotator cuff tear, although a rotator cuff problem would be unlikely to produce pain in the axilla (arm pit) and rib area. Again, in the absence of being able to perform a physical exam, I can't provide you with a diagnosis.

The other possibility is that you have chronic costochondritis, or inflammation of the cartilagenous attachments of the rib cage. Costochondritis typically improves with anti-inflammatory medication, heat (in the chronic stages), and rest. However, costochondritis can take over a year to resolve on its own. Anti-inflammatory injections may be administered locally to the area of most pain to assist in symptom control.

I would recommend seeing if your GP will order an MRI to rule out muscle tear, and you might want to see a sports medicine physician to be properly evaluated for costochondritis as a possible cause of your chronic symptoms.

I hope this helps to answer your question.