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Forum Name: Cardiology Symptoms

Question: Dull, persistent chest pains on pectorals, upper ribcage


 nathomas28 - Thu Oct 29, 2009 12:18 pm

I'm a 28 male, I don't smoke and I work out often. Since May 2009, I've been feeling a dull, light aching feeling at the corners of my pectorals, like the muscles were being pulled down or there was a light pulsing of sorts (hard to explain). It's not painful, just very annoying. Since then, I've been feeling these symptoms more often, though they're never pronounced, and they come and go throughout the day (I notice caffeine makes them worse). Today, my pecs still hurt (there are places on my pecs/side of pecs that hurt/sting when I press on it), as well as the upper part of my ribcage, before it hits the armpits. I press in a certain spot and it's tender to the touch.

I've gone to three doctors. The first doctor said it was GERD, and that I should take over-the-counter heart burn medicine. Being so busy in work/life, I didn't take it as often as I should, but when I did, I felt no different ... and the aching feel occurs whether I'm eating/drinking or not. I told the doctor this, and he had me get some blood work/EKGs done to rule out anything major. Everything came back normal, except my liver enzymes and cholesterol were up a little. A liver sonogram showed no irregularities, so the doctor said to eat better and work out more. I was 242 then (at 6'2) and I ate horribly for years up to that point. Since May, I've been eating better and I've lost 14 pounds. :) The dull pains continued, though.

I went to an Urgent Care to get a second opinion, and the doctor said it was definitely acid reflux, but to make sure, let's get some work done. So, took a urine test (came back normal) and another EKG, which showed I had a incomplete right bundle branch block. The doctor said tons of people have this, and it means nothing, but let's make sure it's not an indicator of something bigger. So I took a Holter Monitor Test and a Nuclear Stress Test, and everything was normal. Still, the aches were there.

Finally, I just recently came back from my family doctor and told him what I'm telling you, and he said that my tests were pretty exhaustive, and that since I'm young, pretty healthy and the test results came back OK, there's nothing to worry about. I told him where it hurt, how I have a bad posture (which often makes my back hurt) and he pressed on several areas of my chest, which didn't produce pain. He said it's musculoskeletal and that if I stand up straight and ease my back, I should be OK. I believe him about his diagnosis, but I don't see how standing up straight can fix this dull aching problem I've been having for months.

In closing, I should tell you that I have OCD, and thus, I always worry, lol. The pain feels like it's definitely coming from my muscle (when I stretch outward, I can hear my chest muscles crackle a bit), and I have reverse posterior subluxation of my shoulders ... don't know if that's affecting/straining anything. Finally, it doesn't hurt when I breathe, I don't have sputum with discoloration and there's no tingling or sharp, shooting pains. The pain I have became more pronounced when I was sick two weeks ago (I still feel a little under the weather) and I find I have to go to the bathroom a lot more than usual.

Is what I'm describing musculoskeletal? What can I do to get rid of this annoying pain? Thanks SO much!
 John Kenyon, CNA - Mon Nov 02, 2009 11:17 pm

User avatar Hi there -- I would concur with all the medical opinions you've received, but especially the final one. This is almost certainly musculoskeletal, and the shoulder subluxaton certainly could be contributory as could poor posture and having carried a good deal of extra weight. Some ways of countering the discomfort would involve stretching exercises as well as careful attention to posture, as people with the combined factors you describe can easily develop thoracic outlet syndrome (TOS) and this may even be the cause of your symptoms. TOS is not dangerous but can be quite uncomfortable, and is recognized when the clavicle and first rib become too close together (usually due to poor posture) or if there is (rare) an extra, cervical, rib causing the narrowing of the outlet. Both the brachial arteries and radial and ulnar nerves pass through this space, so these can be pressed upon as well. For some, specific stretching exercises as well as careful attention to corrected posture (and sometimes losing weight) can resolve or improve this. For others, physical therapy is a very helpful adjunct. For a few, surgery to open the outlet is required, but is usually optional.

I hope this is helpful. Good luck to you and please follow up with us here as needed.
 nathomas28 - Tue Nov 03, 2009 10:08 am

Thank you so much for your insights, John! Having OCD can be tough, but it's nice to know that four different doctors are all pretty much on the same page. I'm also thankful I took the tests to rule out major heart or liver problems.

One last thing: I've noticed my stomach's been upset this past week and a half (it started when I got sick and has stayed), and I just started having a little pressure/soreness on my love handles area, the muscle part. I also get cramps on and off. Could this be connected to the musculoskeletal problem? Or maybe it's a part of GERD, which is causing the muscolosckeletal problems?

Thanks, John. What you do on this site is a blessing.

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