Ask a doctor on the topic of Orthopedics

Pain in the left shoulder blade and left ribs.

March 15, 2016 | 25,00 EUR | answered by Dr. med. Ive Dr. Schaaf

Maybe someone here has an idea for the cause of my complaints or what I can do about them.

It's just annoying to have to deal with pain every day, against which nothing has really helped so far. I am using pain cream/balm and a back straightener to help alleviate the symptoms temporarily.

The only thing that has really helped for a few days was a treatment with Kinesio Tape. I was almost symptom-free for a few days.

I experience the complaints daily, sometimes more intensely than others. The intensity often increases in the evening (associated with prolonged sitting, lying down?)

History:
Backpacking trip (3 months) at the beginning of 2014. Until then, no significant problems (no surgeries, no serious illnesses). The complaints started one week after returning.

Progress of complaints:
Initially:
Chest pain on the left side (heart area)
Accompanied by dizziness and several other symptoms (which I don't want to list here as they now occur rarely)

About 1/2 to 3/4 year later:
The chest pain gradually decreased, but since then, pain (initially mainly) in the left shoulder area, and then additionally in the area of the left ribs have occurred.

Current state:
Pain in the area of the left scapula
>Audible "cracking" (with movement)

Pain in the left ribs (side, about the 1-2 from the bottom and the top ones below the armpit)

Pain in the left ribs (front, about the 5-6 from the bottom)

Constant neck tension

>>It's always the same areas and always on the left side! I have never had complaints on the right side during this whole period.

Previous examinations/diagnoses:
(many of these were done as I initially had various complaints besides the pain)

Blood tests (multiple)
ECG
Stress ECG
24h ECG
Echocardiogram
Thyroid examination
CT scan of the skull
MRI of the skull
Chest X-ray
Lumbar puncture
ENT examinations

MRI of the thoracic spine
Nerve conduction study

Tropical medicine:
Urine and stool analysis
Abdominal ultrasound (liver, bile ducts, gallbladder, pancreas, spleen, kidney, bladder)

>>>All examinations were inconclusive

Orthopedics (1st doctor)
Diagnosis/finding:
Thoracic spine blockage (M99.82G); Muscular imbalances (M79.10G)

The thoracic spine is orthogradically structured. There is increased tension in the left scapula elevators. Weak muscle round back that can be actively straightened. Passive trunk rotation to the left is limited in the thoracic spine while sitting. Trunk lateral flexion is free. CT joint blockages in the middle thoracic spine levels.

Orthopedics (2nd doctor)
Diagnosis/finding:
Left shift, pronounced cracking in the left shoulder, facet pressure tolerance D5/6 left
X-ray thoracic spine 2 levels left shift, flattened kyphosis

Cracking in the left scapula (M89.81, LG), recurrent IVG blockages (M99.82,G)
[Recommendation for consistent complaints: Infiltration with tissue-hardening agents]

Other treatments:
Multiple physiotherapy sessions (manual therapy)
Multiple chiropractic adjustments
Multiple sessions of physical therapy
Ongoing osteopathic treatment over an extended period

Unfortunately, all with very short-term success (hours/days)

Physical activity:
Before the complaints = zero (except for movement at work, about 2-4 km per day)
Since the complaints: Initially light (walking, cycling, swimming)
Currently: Daily trampoline jumping including dumbbells. (1-3 times a day, depending on how often per day for about 15-45 minutes)

Dr. med. Ive Dr. Schaaf

Good morning,

From your information, it appears that there are detectable changes in the area of the thoracic spine and chest muscles on the left side. This corresponds to your symptoms and suggests that the cause is a incorrect muscle tone on the left side, leading to the development of pain.
When muscles hurt, these pains can be triggered by touching the muscle. You did not mention this, so I assume that the tension is causing the small nerves between the ribs to trigger the pain.
In addition, there are also changes in the shoulder or shoulder blade, which I did not fully understand, that are causing the cracking.
Cracking can be caused by a change in the joint, but most often it is due to ligaments, fluid retention, or hardened muscles causing these noises.

Your description suggests that you need to relax the left side in order for the pain to go away.
Possible options include:
- Exercises to stretch the muscles next to the spine
- Exercises to stretch the small muscles between the ribs
- Exercises to elongate the spine
- Applications to relax the muscles, such as heat
- or massage, if hardened muscle groups can be found
- Kinesiotape is great if someone truly understands how to use it and the mechanism of your dysfunction.

I don't understand why you are jumping on a trampoline. This shakes everything up in a "random" way. While it may provide you relief, it supports my assumption of the "offended" intercostal nerves, but it doesn't really benefit you.

You can find good taping at:
- Naturopaths for body therapy
- Orthopedists with this additional training
- Physiotherapists with this additional training.

Taping has the great advantage of working 24 hours a day and supporting your exercises.

Last but not least, you should consider a pain medication therapy, as pain has a memory. In other words, after such a long period of pain, the pain sensation has become independent and may persist even after you have effectively eliminated the trigger. Therefore, it makes sense to interrupt the pain medication for about 14 days with Ibuprofen, Novamin, or similar, to "delete" this memory.

Best regards,
Dr. Schaaf