Deep Rhomboid Pain with breathing

by Amy
(Minnesota, USA)

Deep Rhomboid Pain with breathing suggests a subluxated rib head.

I have recently developed left side deep rhomboid pain. About 14 days ago it started and was extreme pain. I was not doing anything strenuous at the time of onset, but I did feel a tingling "pop" in that area. Within 30 hours of onset, my family took me to the Emergency Room, because I was suffering so greatly. They diagnosed it as "Rhomboid Spasms". I received muscle relaxers and pain medication, and sent home to rest with alternating heat and ice. I stayed home from work for one day after ER visit (desk job, but I use an adjustable standing desk and wear orthopedic support shoes). I have seen a massage therapist, who was able to reduce the pain, but it only lasted about 12 hours. Since then, I have used up all the awful pills, and have continued using over the counter pain meds (Aleve, Advil and Tylenol) to try and take the edge off this awful pain. My doctor has now prescribed steroids to see if that helps.

More about me:
-42 year old female, active, overweight but losing weight, I eat very low carb

More about my pain:
-It does not get better or worse with arm, neck or torso movement
-A deep breath makes the pain sharp
-When I am lying down the pain is minimal
-when I am sitting or standing, the pain is at its worst
-when I am walking, the pain decreases
-however, when I am walking, there is a deep ache in my left calf and the area behind my knee. I do not feel this leg ache when sitting or standing
-Heat and ice BOTH take the edge off

Let me know if you need any more info, but I am desperate to know what to do. I am miserable while working (I LOVE MY JOB), and the pain is making me very grumpy and hard to be around. I just want to lie down to get pain relief. Please help. What else can be the cause of this awful pain?

Apologies for the late reply, Amy. I've been on two weeks leave.

This really is a simple one; the key sign is that a deep breath gives you sharp pain. You have subluxated a rib head in the middle of your back. The primary problem has nothing to do with the rhomboid muscle.

I can virtually guarantee that deep pressure over the offending rib head, just lateral to the spine, will be very painful.

At this stage it may be radiating along the rib, under the armpit, under the breast to the sternum; if so I strong recommend that your chiropractor uses an "anterior thoracic" rather than a heavy P to A manipulation which may aggravate the pain.

This really is one of the simpler things we treat, Amy. You've been led a giddy dance by those are not up on a rib head subluxation.

If there are any complicating facts like a fever, cough, or old thoracic spine injury then an x-ray would be beneficial though this is rarely the case; you have a subluxated rib head. Almost guaranteed!

Let me know how you get on. By the way, apart from having treated thousands of similar cases, I've had it myself. You're not wingeing about nothing; it hurts! Perhaps print this out and take it to your chiropractor with you.

Well done on getting the pounds off; keep up the good work. Thank you for a very well presented case history.

Dr B

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Jan 09, 2018
Neck and shoulder pain
by: Anonymous

Can neck and shoulder pain cause chest pain? Difficulty in breathing and feel pain in chest. I’m not sure whether is rhomboid pain problem. I haven’t consult any MD yet.

If it's breathing related, then the most likely cause is a rib condition, usually the joint between the rib and the spine underneath the rhomboid muscles.

Dr B

Dec 14, 2017
Breathing pain
by: Anonymous

I woke up in the middle of the night 2 days ago with a sharp pain in my mid upper back area. The next day the pain radiated to my shoulder and around to my sternum just as you described, and I couldn't move my left arm without pain.

I saw my GP and she said it was a thoracic muscle spasm and prescribed prednisone. My biggest issue is that I cannot lay flat on my back without sharp shooting pain from back to chest when I exhale. It's not as bad when I lay on my stomach. I also don't have as much pain when I sit straight up and no shooting pain when I am standing.

Apologies, I've been on leave.

Firstly, always take your doctor more seriously than some internet guru; she has had the opportunity to examine you and knows your history.

It's now ten days; are things improving? If not, then I would recommend a second visit to your GP.

There are indeed some symptoms that suggest this may be more complex; the radiation to the sternum, for example. Running your fingers down the chest, is there distinct tenderness over the rib-breastbone junction on the left? Lying on your tum, if someone presses quite hard over the rib-spinal joint is there a very tender area?

However a rib head subluxation usually cause pain with inspiration, rather than expiration. Have you had a cough, or been sneezing?

Does turning your head, and your whole torso increase the pain?

A chest and spinal x-ray may be indicated.

Should you decide to consult a chiropractor, I would recommend an 'anterior thoracic' technique; a hard midback manipulation may increase the sternal pain.

I hope this contributes; let me know how you get on.

Dr B

Nov 21, 2017
is my spine injured or just rhomboid?
by: Lonnie Gail

About a month ago, I started having pain by my left shoulder blade (diagnosed by MD as rhomboid problem). Recently, the pain in that part is much better, but my neck--across kind of from the shoulder blade--has been hurting during the day, and not just at night. Is this the rhomboid doing it, or is it something with the spine.

I believe the rhomboid got injured carrying very heavy school bags to and from work.

The rhomboid muscle is supplied by C5 from the cervical spine, so it is possible but unlikely in a young person unless you've had neck injuries.

More likely is something under the rhomboid, either a rib subluxation or your thoracic spine.

Time to think of another way to get those books to school.

Talk to your parents and doctor about seeing a local chiropractor if it doesn't go away of itself.

Start doing some shotput action exercises.

Dr B

Nov 02, 2017
Rhomboid pain shooting down my left arm
by: Joey Pain

I have similar pain except for the breathing part; my rhomboid pain is on my left side and shoots down my left arm and gives it such a sharp and uncomfortable pain it feels like sciatica.

I've taken Gabapentin, Tylenol Extra Strength, Advil Extra Strength and cyclobenzaprine 5 mg; nothing seems to be working, I have to keep my head tilted to the right in order for the pain to not feel so severe, any advice that would help me is greatly welcomed.

Hello Joey,
First a BIG no-no. Taking many different medications like that simultaneously greatly increases the risk of a severe kidney reaction; and if they're not working anyway, then there's no point in further risking your health.

You are have a condition called a brachial neuralgia; a pinched nerve in the neck that supplies both the midback muscles and the arm.

The first step is to establish as accurately as you can which fingers are affected.

The second step is to get some x-rays of your neck, including 'obliques', followed by a MRI scan if it's an option financially. This is a difficult condition and the more information available to the clinician the better.

Then a careful and thorough examination; I can't promise you any easy road ahead; it often leads to surgery and is one of the more difficult things we treat.

Having said that my second patient this morning reported he is about 20% better with a very similar problem, after only two treatments.

The rhomboid mid back muscle is supplied by the deep scapular nerve, pure C5 which also goes to the arm; here it would seem lies the problem.

Meantime be kind to your neck and upper back; don't carry heavy parcels or a briefcase in the left arm.

Two tests will confirm my suspicions; obviously making an internet diagnosis is highly suspect!

Does turning your head to the left and then looking up provoke upper back and perhaps arm pain? This is called Spurling's sign.

Is the upper limb tension test positive. You can find both these tests by using the Site Search function at Chiropractic Help. I wish I could be more positive; rhomboid pain shooting down the left arm is usually difficult.

Let me know how you get on and whether those two tests were positive.

Dr B

Aug 09, 2017
Similar Pain
by: Jason

I feel like I am having a similar problem. My left Rhomboid muscle hurts from deep within. Often pain is minimal while lying down and sitting down is the worst. The pain sometimes shoots to the front into my chest sternum. A couple of ribs are sore as well. Walking does not aggravate the pain neither does arm movements unless there is pressure on them in cases of lifting or exercising like doing push ups. When the pain does flare up after exercising, my Rhomboid muscle gets really sore causing me to avoid arm movements. The pain sometimes runs from the Rhomboid muscle into the edge of my shoulder blade. Also, it is not that I cannot move my arm, but rather I avoid moving it to avoid aggravating my Rhomboid muscle. This is only after exercising like doing push ups or if I go heavy on the band tensioners. Normally, arm movements do not cause me any grief.

So doc, if you could elaborate if this a rib head issue as well and if it indeed is, is there a specific scan (like a x-ray maybe) that can pin-point the problematic rib. Also, doc if you could explain or maybe post links to what a P and A adjustment and the Anterior Thoracic technique are, that would be great. Just trying to learn what these techniques are and if my chiropractor is following them or not. Thanks.

Hello Jason,
This is diagnostically a hugely difficult area; for example the rhomboid is supplied by C5, so it can be a neck issue; likewise a lung condition, various pathologies. Rule of thumb: if it's not getting better despite treatment, get a lung x-ray taken.

However, this certainly sounds from a distance like a rib issue; the subluxations are so small, but extremely painful, I know I've had it myself and treated tens of thousands, so can't be seen on x-ray or scans; they would rule out other pathology though, so certainly useful.

If the pain is referring along the rib to the sternum, then I find that a heavy adjustment in the middle of the back, P to A, posterior to anterior, just makes it worse.

An 'anterior thoracic' adjustment, usually done with you lying on your back, doc's fist under the offending rib, and with the two of you slightly embarrassingly face to face, thrusting from anterior to posterior is usually more effective. Also done sitting or standing.

If there's a painful spot over the rib-sternal junction then it's causing a costochondral subluxation and, if there's a palpable lump, what's knows as Tietze's syndrome. Find both using the Site sell function at Chiropractic Help.

Chronic rib issues can certainly be difficult, they respond but tend to occur; sometimes a monthly visit is the only option to keep it under control.

I hope this helps; perhaps type it out for your chiropractor.

Dr B

Mar 18, 2017
This is what I needed to hear
by: DBP

Wow, I have a rhomboid muscle strain that has now radiated to rib when breathing in; and pain under the breast bone to the sternum! Exactly the same thing. I'm hoping that physical therapy will help soon!

If it doesn't, consider a chiropractor; rib pain is one of the things that we excel in; but a heavy manipulation in the middle of the back is not a great idea; may make the chest pain worse.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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