breast bone/rib pain

by angelina
(new jersey, USA)

I had my gallbladder removed a few months ago. Right before then I was having pain in the upper right quadrant under my breast and wrapping around to my back. Post removal, the pain never left and has spread to my left side as well. I have started to feel it in my back and still under both my breasts. My regular doc diagnosed as costochondritis.

Physiatrist says I have a rib sprain. Rheumatologist suspects herniated thoracic disk. I'm working on getting an MRI. XRay did show some degeneration of thoracic spine. ESR and CRP very high. WBC normal. Pain is mild to moderate. Limits some range of motion when trying to bend backwards. I feel swollen around the bra area, but no one can see it or feel it. Ruled out truncal lymphodemia with a specialist.

Any ideas?

Hello Angelina,
This certainly sounds like a rib cum costochondritis condition.

Clinically, a lower thoracic rib subluxation at the costo-spinal joints can radiate along the rib and appear like a gallbladder condition. But then palpation under the ribs in the RUQ isn't particularly painful and an ultrasound scan of the GB and liver would be negative. If you run your finger along the lower ribs in the mid axillary line is it tender?

Costochondritis would give you quite extreme tenderness as you run your fingers down the rib joints, just medial to your breasts. Palpate, starting from top and moving down towards the xiphisternum. Is it unusually tender, usually unilaterally but can be bilateral?

Finally, Tietze's syndrome is a progression of costochondritis where a palpable lump forms over the costosternal joint. Can you palpate it? It's often associated with indigestion. On the left folk often think they're having a heart attack.

Thoracic disc herniation is rare.

That raised ESR and CRP is certainly worrying. I'm unable to comment there.

I hope all this contributes to your conundrum. One small caution; heavy manipulation in the middle of the back will often increase the sternal pain. I favour an "anterior" thoracic technique, should you decide to consult a chiropractor.

Dr B

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