Friday, October 24, 2014

Wednesday, February 11, 2009 WSUChris, Community Member, asks

Q: Chronic pain beneath rib cage on Right Side

  I am 24 years old and in very good shape. I used to smoke for several years and drank occasionally. For over a year I have been experiencing pain under my right rib cage. I have had several tests done (blood work, ultrasound, urine analysis) but no doctor has been able to figure it out. I took a nasty spill about 7 months ago and fell on my ribs but I feel like that should have healed by now? It seems to me there is obvious disfigurement (uneven from the left side) from the injury but it almost feels like it is radiating from under my ribs . This has become VERY depressing and frustrating as I know I am in constant discomfort but no one can help. I feel like I will be in pain forever!

I have not been able to correlate the pain to a certain type of food or activity and nothing helps alleviate it. I would really really appreciate any suggestions or ideas for treatment. Thanks! 

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Answers (15)
2/11/09 6:58pm

Without examining you and getting a detailed history, I am unable to make a diagnosis. So, I will speak in generalities about what this could be.

 

Injuries to the chest wall can injure bones, muscles, or nerves. So, I would be looking at all of these things on exam. I would ask about pain with breathing, coughing, reaching, pulling, or pushing. Is this pain in the front, side or back? Is there numbness, tinglling, burning, or other abnormal sensations?

 

One possiblility that comes to mind and is often overlooked is an injury to the Long Thoracic Nerve with innervates the Serratus Anterior muscle (that muscle covers the back of the chest wall and assist the shoulder movements; Michael Phelps has a very well formed Serratus). If this muscle is atrophied (smaller from nerve damage), then the chest wall will look assymetric (deformed) compared to the other (normal) side. The Long Thoracic Nerve can be injured with surprisingly little force like reaching to swat a fly. A Physical Medicine and Rehabilitation (PM&R) specialist can make this diagnosis, sometimes with the help of a nerve/muscle test (electrodiagnostic study).

 

Another possiblity is a damaged intercostal nerve (nerves that are "between" the ribs). These nerves branch out all over the chest wall and are superficial enough to be easily injured with a fall.

 

Other possiblities exist but in reality you need a PM&R specialist to look you over. We specialize in post-traumatic injuries of the nervous system and musculoskeletal system.

 

Dr. Christina Lasich, MD

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Steve, Community Member
12/25/10 4:08am

My wife lifted a heavy suitcase and ended up with intercostal nerve damage.  After  10 years of drugs, PT, TENS, injections, and radio frequency treatments, she is still in constant pain.  She has had no surgery and has never used a drug pump.

 

What do you recommend as a course of treatment for intercostal nerve damage? 

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TAMMIE, Community Member
3/19/09 4:00pm

HELLO CHRIS, AFTER READING ABOUT YOUR PAIN I FELT COMPELLED TO WRITE TO YOU REGARDING YOU.  I CAN TELL YOU WHAT MY CHRONIC PAIN IS LIKE TO SEE IF YOU CAN RELATE.  THE PAIN I EXPERIENCE EVERYDAY IS WHAT I TERM AS A "SIDE ACHE".  THE PAIN IS ALSO IN MY RIGHT RIB CAGE AND FEELS EXACTLY LIKE WHEN YOU GET A SIDE ACHE FROM RUNNING.  FORCING YOU TO STOP AND REST BECAUSE YOU JUST CANNOT GO ANY FURTHER!  AFTER MANY YEARS OF SEARCHING INCLUDING VARIOUS MEDICAL TESTS I FINALLY GOT AN OFFICIAL MEDICAL DIAGNOSIS!  INTERCOSTAL NERVE DAMAGE. I HAVE BEEN LIVING WITH THE PAIN EVERYDAY FOR THE LAST 12 YEARS.  I DO HAVE SOME SUGGESTIONS FOR RELIEF:  I TAKE AN ARTHRITIS MEDICINE EVERYDAY WHICH REALLY HELPS WITH THE INFLAMMATION.  AS SOON AS I FEEL THE PAIN COMING ON I TRY TO FIND A PLACE TO SIT AND REST.  FOR ME, DOING AN INTERVAL SIT AND STAND IF I HAVE A LOT OF ACTIVITY TO DO REALLY HELPS ME FROM GETTING A SIDE ACHE.  WITH ME, THE PAIN DOES GO AWAY CONSIDERABLY WHEN I SIT DOWN AND LAYING DOWN HELPS THE MOST.  STANDING AND WALKING IS WHAT BRINGS ME THE WORST PAIN.  IT HAS TAKEN ME ALOT OF YEARS TO LEARN HOW TO CONTROL THE PAIN SOMEWHAT SO I CAN LIVE A FAIRLY NORMAL LIFE.  I HOPE THIS HELPS YOU.  Laughing

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adamm, Community Member
4/20/09 10:44am

Sorry this isn't an answer, but I am also 24, quite fit, and have been suffering with this same thing for a year now. If you find anything that sorts you out, I would appreciate you telling me! adammarples@hotmail.com

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Mike, Community Member
5/ 2/09 11:18am

I am also 58, quite fit, and have been suffering with this same thing for 4 year now. If you find anything that sorts you out, I would appreciate you telling me!

 

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polkmattie, Community Member
6/24/09 8:13pm

Sorry this is not an answer..I have been experiencing a sharp constant pain just under ribs on right side for about 4 months now.. One day I have constipation and next diareha.. My daughter accidentally touched me the other day and I almost cried..I have had my gallbladder taken out and every thing I look at says gallbladder, but I do not have one.. 

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Kymb, Community Member
8/ 3/09 1:48am

Any ideas of what it is yet? I to had my gallbladder out 1/2009 and have had the same symptoms. I go this week for an ultrasound.

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cherokiimslm, Community Member
11/ 5/09 4:03am

especially for ppl withot gall bladder SOD should be looked at i THINK it is checkd for with an ERCP (test)

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Addie, Community Member
7/ 2/09 9:11pm

I might be a bit late here, but I have the same pain.  I'm pretty sure it's radiating from my back..that is a referred pain, through the nerves.  I visit my chiropractor and the pain stops.  When it comes back I have another adjustment.

 

There is a lot of pain that people put up with that shouldn't just because they don't believe in chiropractors.  I have been going to one for thirty years, as I have scoliosis and other chronic back problems.  The relief I get from adjustments has kept me going.  Im reasonably fit and 57 yrs old.

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dolly, Community Member
7/30/09 4:10pm

I am currently suffering from mid right side to back pain for the last 4 days.  Felt the pain in the middle of the night.  I started seeing my chiropractor because I believed on of my ribs to be out of allignment.  It was and it helped, but the pain continues because of the imflamation.  I also visited my orthopedic for a different issue and mentioned it to him.  He is very concerned as the ribs protect your kidneys and lungs. His advise is to see an MD internist for an MRI, which will give a peak into the kidney. He says it could be a number of things such as kidney stones, cyst, fluid in the lung to worst.  I would recommend you getting an MRI to rule out something serious and also see a chiropractor.  I use to work for one and they're are many invasive procedures that doctors who don't understand chiropractic will have you do such as surgery. 

 

P.S.  I'm also very fit.

 

Good luck!

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cherokiimslm, Community Member
8/26/09 3:57am

Hi, I have been having the same pain as  you for more than 2 yrs, docs say oh nothing is wrong, its making me mad and crazy you cant have people telling you everything is fine when you KNOW that you KNOW you live in pain 24-7. My pain is constant, it goes from a bloated organ feeling under the right rib, to sometimes feeling like that organ is going to bust feeling, when it gets like that I literally cant sleep b.c. cant get any comfort in any posistion-I am with the other folks here if you find anything let us know............I was very healthy till this hit me at 26

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Shelley58, Community Member
8/30/09 8:29pm

I am a 58 yr old female with the same pain.  They took my gall bladder out and the pain remains.   I have a few small kidney cysts that "can't possibly be the cause of pain".  There is a small nodule in my lungs "that is nothing" that is infarction caused by multiple blood clots in both lungs 1 1/2 years ago from chemo.

 

The pain is bad and is mostly relieved by lying in different positions.  I am too tired to follow up any more.   When I mention it doctors dismiss it because I have had so many medical problems and think they are tired of my complaints.   (cancer, pulmonary embolisms, 8 surgeries, etc.)

 

It would be so nice to know what the pain is.   It affects everything I do.   Who knows, maybe it is cancer spreading again.   It's a good thing there are anti-depressants and anti-anxiety pills.

 

Shelley

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Terri, Community Member
10/ 2/09 7:45pm

Hi.  I'm 57 yr old female.  I'm having that too.  They took out my gallbladder in 2003 and I'm a Stage III colon cancer survivor (3 yrs - 3 surgeries).  When I had my cancer surgery, they actually thought I ruptured my appendix (it was a big malignant tumor), so I KNOW this isn't my appendix.  That's gone too.   I had a kidney scope & a resulting stone 2 years ago  (they dislodged a stone scoping my kidney to check for damage from radiation & it got stuck-after 4 days getting jaundiced, doubled over even with shots of demerol and being inpatient the dr. said "guess we shouldn't have scoped your kidney".  haha.  Dr. humor escapes me sometimes!). 

 

I have heard:  "it's scar tissue".  Yeah right.  Then they said it's my ventral (surgically caused) hernia (which I actually had to tell the radiologists half a dozen times "WRONG SIDE - That is on the LEFT side, the pain is on the RIGHT")   I had an abdominal ultrasound.  I had 2 CT scanS.  "Except for your hernia, everything "normal".  Except the pain.  Still there.  Then I got put on the back burner because the CT's were "normal".  A prescription for Prevacid.  Then one for Zantac or whatever it's called.  I said "I don't HAVE heartburn or food or acid issues!!"  I was told "Try it".  I did.  Pain still there.  I about gave up.  I didn't even notice but people at work said I'm holding my right side.  But I did notice the pains while I'm working and no comfortable sleeping position. So back I go.   Then I got Ambien, anti-depressants and VICODIN.  Why?  Because my husband died a year ago from esophageal cancer so now-a year later, all of a sudden I'm depressed or nuts or whatever.  Who knows what they thought.  The vicodin was my limit. (my husband became addicted during his cancer fight and my drs. know darn well I am NOT taking narcotics without good reason). That was my clue that I was being written off.  I went to my oncologist.  I'm telling the oncologist about the CT and nothing showing up & the pills. 

 

He said "So they gave you the prescriptions and then what?"

I said "What do you mean, then what?" 

He said "What about the pain?  Is the pain gone?"  I said "NO!!" 

He re-ordered  labs & URINE.  And re-ordered Urine.  And Again.  Surprise.  Microscopic blood in my urine keeps showing up.  My primary drs. NEVER did a urine check.     Monday 10/5 I'm having endoscopy (ERCP) & colonoscopy.  He wants to check everything all the way through.  If he hadn't, I would have demanded someone due an ERCP.  Your history sounds a bit similar to mine - with cancer & that.  DO NOT give up.  Maybe I am lucky with the oncologist I have, I don't know, but can you talk to your oncologist?   Mine told me - he is NOT thinking cancer.  He is thinking there's a miniscule gallstone or kidney stone there somewhere and ERCP should find it.  Not the greatest test, but I'm doing it.  Personally, with your history-sounds like mine a little bit - you have GOT to be your own advocate.  You know your body.   I told my oncologist "something is not right" and he immediately stopped me and said "I believe you - it's your body, you should know-you don't have to convince me."  Do not think cancer and FYI - your medical "problems" are not tiny for sure.   Keep trying for an answer.  If they find anything on me next week, I will update.   Terri

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cherokiimslm, Community Member
11/ 5/09 4:07am

Hi, if its not a bother I would like to hear exactly how your pain feels and if you find out what the problem is and have you been getting bladder infections??? Thanks

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catalina, Community Member
2/19/10 11:41am

I have the same pain.  Had my gallbladder removed Dec 08. It feels like pressure and a stitch on my side.  Need to go back to the surgeon or my family doctor but I am afraid I have cancer or they won't find anything.  Did you find out what your pain was.  Also, I am a Registered Nurse and find it difficult to trust frew physicians with my body.

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bneffers, Community Member
10/30/09 1:36am

Hi.... I know my response will not help, but your pain is closest to what I had experienced and what I am experiencing. We are, to young for this.  My issues started at 26 and her I am almost 29  Still nothing.  I'm sure you have had every test in the book. Nothing appears wrong. So have you found out anything yet??

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cherokiimslm, Community Member
8/26/09 3:58am

btw could be iron overload for some folks or SOD

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Leslie, Community Member
9/ 4/09 9:53am
Hi, this is not an answer but I too have been suffering from the same problem for the last 7 years. I have had like 4 endoscopy (s), 5 ultra sounds, 4 ct scans, barium meal tests, liver tests, had my uterus + 1 ovary removed in the process of finding whatever is wrong. The surgery must have interferred with my digestive system making it 'lazy' no consipation - just lacks the urge to pass. The pain persist and gets worse by the day. I cannot lift anything e.g the weight of my handbag causes so much pain. I cannot work around the house either e.g chopping things like onion/tomatoes on the kitchen board causes lots of pain. I'm seeing a different doctor (gynae) who's proposing to remove my remaining ovary ... it's quite frustrating. Reply
cherokiimslm, Community Member
11/ 5/09 3:48am

Hi sorry you are in pain...but you are DEFINATELY not alone=you know Ive quit complaining about it b/c Im pretty sure no one believes me anymore, since they cant firgure out whats wrong and constant non stop pain, man it can really make you turn into an angry person, I hate this, really do

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cherokiimslm, Community Member
11/ 5/09 4:11am

I wonder if anyone else can relate to this?? I have had a very VERY hard time sleeping with this pain under my right rib, it feels like pressure, like somthing in there is about to pop, so I noticed that if I stick my fist under my side when I lay on it, it helps b/c its like Im pressing the pressure feeling back in, I got one of my sons soft play balls, and I actually stick it under my right rib area, and that helps me get to sleep?

/

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Rachael, Community Member
11/12/09 5:30am

i have had thsi pain since feb this year..its under my right boob,,starts sometimes in the middle of my boobs and affects my right side..i was in pain that much in feb i had to go to the hospital...they checked my gall bladder and bloods i have had ultra sounds exrays..etc..and nothing has come up..sometimes its tender to touch..even when i breathe in it hurts some times and cough..and stretch..it can spasm..they reckon its muscle related,,i notice when i lift smething it stretches..feels like a pulling pain..like a stitch..drives me mad....i know im not dying as i cant lose bloddy weight..i actually thought it was my bra at one stage...this pain is on and off....at least i know im not alone.....

 

Rachael.

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netty, Community Member
6/ 5/10 2:06pm

Hi Rachael, I have exactly what you have described. They actually treated me for Pleurasy at one point. It comes and goes with no obvious cause. I ahd a full scan last time but they fond nothing and mentioned some fancy named infection of the nerves between the ribs.....I'm actually suffering a flare up at the moment and am off to the docs again Monday...will keep you all posted.

Jeanette

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JRJ, Community Member
5/ 3/10 4:50pm

I have the exact same thing. Im 31 also, booze here and there, reasonably fit and all of a sudden about 6 months ago started getting this pain on my right side rib cage. Ultrasound nothing, got a CT Scan of chest/lungs etc today so we will see if anything shows up. I got a hundred bucks that says nothing does. Honestly man i think its a nerve or something in your back that is causing this pain. Try hardcore stretching for about 20 minutes before you go to bed and right when you wake up. My doctor thinks mine is muscle spasms and he gave me some muscle relaxers...believe it or not it worked. The only problem is i take them at night and they knock me right out and im tired the entire next day. So screw those things, ive been stretching a ton and its helped me tremendously...always comes back but i can relieve it for a few days here and there!!!

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softballer959, Community Member
12/ 4/11 3:13pm

Hi Everybody,

 

I have the same pain all of you speak of.  I have been to 15 different doctors in 3.5 years.  Many told me I was making it up but others said it might be nerve pain.  After being told it was nerve, no one could do anything to prove it.  I googled every word that was used when speaking of nerve pain and I came across the Institute for Nerve Medicine in Santa Monica, CA.  I contacted them and there is a special MRI process that can be run at approximately 14 locations across the US.  Being from NC I went to St. Petersburg, FL to have the test run.  It showed that my T10 nerve was entrapped in my ribs.  I met with the neurosurgeon two days ago and in the process of scheduling surgery.  If you think your problem might be nerve related, please visit the website at www.nervemed.com.  If you have any questions, please feel free to email me at kimberly_tew@yahoo.com.  I hope this helps some of you. 

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jcas, Community Member
4/ 9/12 4:31pm

Hi 

 

Abdominal pain under the last right rib of your rib cage can be eased with soluble migraine tablets (paracetamol) and a codeine tablet, please watch dosage. I am taking this with a codeine tablet prsently for the pain (and watching dosage!).

 

 symptoms: stabbing/dull ache intermittent now constant. Caused distended stomach/peritonitis symptoms pain moderate to severe. right side flank pain and back pain on occasion(too many pain killers?).. during course of 4-5 yrs nausea, fatigue, loss of appettite,metal taste in mouth for a time, peritonitis rigid abdomen for 6-8 months, affected breathing and walking (diaphragm?).. stomach now feels swollen mainly, worsened by eating fatty and sugary foods.. acid /bile? feels like burning colon? when released after eating food.. and pain also there 2 hours later but not necessarily the cause (pain always over belly and stinging pains now over belly button.., righ flank pain)..

 

I am thinkingit could be : Colon/gallbladder bilary tree/kidney/ducts/duodenum/pancreas/appendix/liver/kidney/inflammation of abdomen..? Distended stomach due to leakage or ascites ??Big guess though!

 

Have had : blood/urine/stool tests - clear

ultrasound abdomen / vaginal ultrasound -ovaries clear

Endoscopy/colonoscopy clear(tube up bottom wasn't successful).

MRI- clear

 

Bladder shown to have quite a bit of urine in it after emptying (after internal ultrasound of ovaries), i thought it was empty.. so if any of you have seen a urologist can you let me know please!

 

Am due for laparoscopy next month, will let you know if it shows anything..

 

If any of you had a liver specialist/pancreas specialist in relation to last rib right side abdo pain, can you also let me know please.. !

 

 

hope this helps.. it is very distressing condition 4me as it affects ability to eat food, and basically do anything.. :)

 

 

 

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jcas, Community Member
4/17/12 5:15pm

Thinking Hugh Fitz Curtis (perihepititis/mimics inflammation of gallbladder cholec(srry spllling)..??

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jcas, Community Member
4/17/12 5:24pm

Courvoisier's law (or Courvoisier syndrome, or Courvoisier's sign or Courvoisier-Terrier's sign) states that in the presence of an enlarged gallbladder which is nontender and accompanied with mild jaundice, the cause is unlikely to be gallstones. Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicated possible malignancy of the gall bladder or pancreas and the swelling is unlikely due to gallstones.[1][2]

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jcas, Community Member
5/12/12 2:17pm

Hi All FYI  -Laparoscopy Gynae

 

No endo.

Fluid cyst; small lft ovary

Perihepatic adhesions 

 

no cause of pain yet found

 

Pending gastro tests on liver....

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Matthew, Community Member
12/29/12 9:57pm

Hey, is your pain acute and stabbing? or is more of a dull discomfort. I'm 20 was an athlete prior to my back issues which started 2 years ago. I had always played basketball and tennis but never lifted - two years ago i began to weightlift and in aroudn the third month one day while on a decline bench press i found that i couldnt lift any weight with my right arm- there was a mild discomfort sensation under the right armpit area but nothing excrutiating, the weight was minimal and i literally couldnt put anything up (this was last time i ever went to a gym) for the next couple of weeks I had a shooting pain in the right rhomboid area (vertically shooting) that came about when I'd lean forward in bed or at a desk. Doc diagnosed strained rhomboid. few weeks later it transformed into total back discomfort that persists regardless of position/activity. 2 years later after 5 mris, body scan, bone scan, months of PT, chiro, rhuemotologist, sports med, and osteopath OMM i sit here with the same 24/7 unceasing back problems. its more an extreme sense of discomfort and tightness than it is a sharp pain. its predominantly in my rhomboid upper/middle back area from shoulder to shoulder and then my lower back (SI joint area) and more recently (3 months) ive had a dull pressure throughout my right side rib area. also the greatest point of discomfort often shifts - for ex: one hour my neck and traps might be killing me, then all of a sudden i notice my ribs aching and the neck will more or less subside. then a few hours late the mid back will be worse and the other points will be less noticed. doctors have speculated this this is unrelated- but i also find it odd that i have a rounded triangular shaped red rash right above the middle of my butt (waistline of pants). any information would be tremendously appreciated as i cannot really enjoy many activities (walking, standing and sitting are all extremely uncomfortable) the constant sensation and tightness has really taken a toll on me bc there isnt a single second where my mind is not clouded by this feeling of longing to just be comfortable. if im in class, i try to focus but i always fidget to try and find a little relief. im getting very tired from all this stress so any, literally any point in some direction would be appreciated

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matt, Community Member
2/10/14 11:15pm

Not sure if you will see this but it might help you out. Or you might have fixed your problem by now? Your symptoms sound exactly like mine. Sitting in a chair or any pressure on my back/arm used to be absolutely miserable. Using a computer was torture. My symptoms started roughly 1.5 years ago. Feels like a deep ache in rhomboid and shoulder blade/armpit and back or side of arm. Doctors first thought I had simple tendinosis or overuse problems but physical therapy for my rotator cuff did nothing. Any kind of pushing (pushups benchpress) caused a pain in my armpit/shoulder blade, side raises also used to hurt. Well good news is my pain level has gone down significantly since I started focusing on strengthening my shoulder blade muscles. I still get pain with any pushing but atleast I can sit without a ton of pain now. My doctors noticed i have a mild winging scapula (my shoulder sticks out when pushing or with certain movements) but they dont seem that concerned. I guess a winging shoulder blade can be a result of my body compensating for a shoulder problem. My doctors think I torn my labrum which is pretty much a ligament or cartridge type structure that holds you arm in the joint. If thats the case I will most likely get surgery. I'm still not entirely convinced though, will be talking with my doctor in a couple weeks to rule out a torn muscle around my shoulder blade or a nerve impingement in my neck known as "thoracic outlet syndrome". You definitely need to take a very proactive approach with your doctors if youre not getting the help you need then get a second opinion!

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matt, Community Member
2/10/14 11:19pm

Oh and one more thing! I never really had weakness per say it was more pain then anything. You're see weakness just scream nerve damage, especially with pushing I'm thinking "long thoracic nerve damage" which is a nerve that goes to the serratus anterior shoulder blade muscle. If the serratus anterior is paralyzed you can't really use your arm at all, some people even have trouble rating their arm. Look in the mirror and seem if you shoulder blade pops out when you raise it straight in front you like pushing on a wall.

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By WSUChris, Community Member— Last Modified: 02/10/14, First Published: 02/11/09