Expert: Dr. Timothy K. Durnin - 5/20/2007

Question
I am a 30 year old male that has been experiencing for several months on and off pain in my shoulder (specially when doing weight lifting at the gym) but also a pressure like pain in my chest-rib area that something feels like a difficulty to breath. Breathing and pain is not a problem while exercising even on high cardio routines but rather after. I have been checked with an EKG, chest X-ray, complete blood tests and everything was Ok. Can a shoulder pain irradiate pain symptoms to the chest area?

Answer
Hi Claudio,

Without a more thorough history and physical exam, it is tough to say. From what you describe it sounds like sterno-costoarticulitis, this is inflammation at the junction where the rib meets the sternum.

Without knowing exactly where your chest pain is, what aggravates it and no orthopedic evaluation, all I can do is give you my best guess.

Since all your other critical tests are negative and since the above described condition won't show up on an x-ray, CT or MRI only a physician can definitively rule it out.

I need to know if it hurts to cough, if it hurts to press on the area I described and if there is a history of repetitive=e trauma or past sudden injury to the area.

It is rare to have shoulder pain radiate into the chest. I suspect you may have a couple things going on.
First find out exactly the cause of the shoulder pain ie; labral, A/C, rotator cuff tear or simply a sprain. Once you do that, there are several thing that can go wrong in that area. TOS or thoracic outlet syndrome, cervical radiculitis, meiastinal mass and a whole host of other conditions that have to be worked up following a known diagnosis for your shoulder.

Have it looked a by either an orthopedic surgeon or a Chiropractor or both. I would go the Chiro route first, bring in all your test results and in short order he can differentiate what is the source of your pain. You already have a good head start, you just need to finish with what it could be knowing what it isn't. Many times doctors arrive at a diagnosis based solely on what we know has been ruled out, so the only thing it could be is what we can't objectively quantify with tests. We diagnose different types of headaches even though you can't see one on a test. The same goes for many other types of conditions, your doctor should be able to arrive at an acceptable diagnosis with a little indepth history taking and palpation, range of motion and orthopedic and neurological tests. These are done without machines, all hands on. It also matters which side it's on, you didn't tell me know if it's left or right. Even if you did, you will still need to see a D.C. or Ortho to conclusively diagnose you.

Once you do get a Dx, notify me and I will instruct you on the best way to treat it and avoid relapse.

One more thing, when you say "blood tests" this can mean many things. I doubt they bothered to do the correct tests, they rarey do, I would make sure they ordered a cardiac CRP and C-reactive protien along with the basics.

Hope this helps,
Dr. Timothy Durnin
drs.chiroweb.com