Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Pain under left shoulder blade / rib pain

For the past few weeks I've been having pain under my left shoulder blade in my back. I've also been waking up at night with rib pain. (Stomach sleeper) The other night I tried to lay in bed and I had really sharp pain in my chest bone. It seemed to go away when I layed on my back with my head/chest elevated with pillows on the sofa.

I saw my family dr yesterday for a physical and I should of mentioned something to him, but being stubburn and thinking I'd be fine I let it slid, by mid afternoon yesterday I was wishing I would of spoke up.

I know my blood pressure was up yesterday 104/164, which in the past for me is an indicator that I'm usually in more pain then I realize. (Family dr said he was going to send my rhuemy a letter letting him know we need to keep an eye on my pain & blood pressure).

I'm just wondering if anyone else has had issues like this and what helps to releave the pain? (Been doing heat, muscle relaxers & pain pills) I don't see my rhuemy for a few more weeks.

This past summer I had issues like this and ended up in ER, the ER dr thought it was plurisy, but no real diagnoses was made. I had pain when breathing last time.

Any thoughts would be greatly appreciated!
Kim

Hi Kim! I get rib pain/soreness every day. I especially get sore by my diaphragm. I also have pain between my shoulder blades. Deep breathing exacerbates it. The pain is felt throughout my rib cage. In the front below my pecs and on the side. I believe that your ribs are a classic spot for AS involvement.

Farinelli

My ribs and sternum are always painful, especially when taking a big breath or putting any pressure on the sternum or the bones connected to it, like the collar bones etc. I can't imagine sleeping on my front.

Hope you find solutions, Kim.

I am a side sleeper and trying to learn to sleep on my back because my shoulders hurt too much to lie on them. It's a real struggle getting to sleep on my back. I lie there longing to turn to one side.

Hi Pianoplayer - Yes from this side of the globe. Just in/under shoulder blade and painful sternum. Started with sternum about 7yrs ago. Was cleaning out rabbit/guinea pig cages when, *Boom! Pain hit me straight in the sternum. Couldn't think 'what' it was. From then on steadily got worse. Then one day noticed that my sternum was *huge*, sticking out, most horribly, and noticeably. Been like it ever since. IF I palpate the sternum, owie-owie. No like (Sternum 'used' to be quite cartiliginous (is there such a word...'LOL') but noticing that it is getting more 'bonier'. Weird. Still hurts to palpate though.)

As for under the shoulder blade. Painful. Feels like it has been like that for years and years - but more likely 15/20yrs. Just getting progressively worse. Sigh. Does calm down from time-to-time, then flares up again.

Rib cage? Yep. That is **Horrible A continuing ache. Sometimes sort of stabs me - decidely unpleasant.

Sleep? Sometimes diff. Certainly NOT on my stomach... No way. Sleep best supported on pillows on the sofa - which has same height, high back and sides. Wonderful for supporting shoulders and spine. Put my feet up on a pouffe, blanket and/or douvet over me, back supported by down pillow and neck supported by shaped neck pillow. Fall asleep - and get a far better sleep than I do when lying in bed.

IF necessary, then take a breakthrough pain killer, Remedeine or Trammodol, and an antiinflammatory, Celebrex 200. Cuddle down with a hotwater bottle - or two.

IF in bed. Then support, almost sitting up, with 7 down pillows and my shaped neck pillow. Three hotwater bottles, lie on my back. 'When' able, do lie on my side from time-to-time.

Rib cage. Lower right side, and slightly to the back. Been really, really painful. Culminated Oct 07 with pleurisy. Could not breath, deep breaths were OUT - was in agony. Couldn't even stand up straight, it hurt soooo vey much. Was crawling around, clinging onto walls, anything to get me steadied and propelled. Ended up in hospital, on oxygen. Hope I NEVER get a repeat of that! Was in a devil amount of pain. Still have problems with rib cage - doctor at hospital opined 'prob fusing'. Lovely! (It's sticking itself at me right at this minute. GGRRrr)

Don't suppose that has helped in the leastest bit, but know that you have ALL sympathy from this part of the globe.

Take care.

Molly C (France)
Keeping on Keeping on (nowt else TO do but, keep on keeping on!)

Kim

I hope you are feeling better soon.

If it's any thing like I have had, it is very very painful. For me it lasts about 3-5 days and then it goes away. But I have not had that pain for several years now.

If the pain continues you might want to consider talking to your doctor again. Maybe he would be able to help.

i can't even fathom sleeping on my stomach. if my back is killing me so sleeping on my back is painful and can't sleep on my sides because that always hurts the SI, i'll try to lay on the stomach for a little relief, and after only minutes, everything hurts especially my neck from being turned, and if i don't turn my head, i think i'd suffocate into the pillow...... so i really can't imagine being a stomach sleeper.

i used to sleep on my left side, but injuring my upper left back forced me to my right side. having SI involvement, forced me to my back. sleeping on my back with pillows under my knees and a flat feather pillow under my neck is really the only way i can sleep. and this is usually ok unless my upper thoracic spine is bothering me, then i might have to sleep with an ice pack under my thoracic back or sleep with the pillow under there to, to put a slight curve in my upper back. but mostly, flat on my back as described works well.

the left upper back (every inch of it) was horrible for the first few years. lots of PT with lots of ultrasound (2x a week, then 1x a week, then 1x every 2 weeks for about 2 years; now, as needed) and physiatrist with lots of trigger point injections (3-4 at a time, 1x a month, for a year; now, as needed) helped my back tremendously. it was a spasming mess. now, its managed. the trigger points and spasms were in the rhomboids, intercostal muscles, traps, lats, infraspinatus, supraspinatus, teres, etc (thus included under the shoulder blade).

on my own, ice seems more beneficial than heat, but cycling between ice and heat is the best. i'll use heat when a little achy, or its mostly muscle spasms, but for real pain, real inflammation, its ice.

sorry to hear of your pain. the only thing worse than my upper back problems has been the SI. but the ultrasound and then trigger point injections got me to where i can mostly manage with ice and heat and stretching and mild strengthening.

sue

Hi Sue,

Could you tell me what medicine was in the trigger point injections. Was it cortisone?

Danny is having pain all over back, but most painful points are left shoulder and neck. He wants to go for a cortisone shot, which he has had in the past. It helps for a few months.

I wanted to know if there was another mediciation that was injectable that didn't have the side effects that cortisone has.

Thanks,

Laurie

if its an inflamed bursae or joint, then cortisone is injected.

if its trigger points (scar tissue in the muscle) then lidocaine (or a similar anesthetic) is injected into the belly of the trigger point to release the scar tissue. its really just the action of the needle that releases the trigger point,
but the anesthetic reduces the chances of rebound.

so, really cortisone and lidocaine (and other anesthetics) are not interchangeable.

but i've also had cortisone injections into joints when absolutely essential,
and they worked like a charm and i had no negative effects that i'm aware of. systemic steroids like prednisone and local cortisone shots don't have the same overall side effects.

the doctor should know how to proceed, i would imagine.

sue

Hi Sue,

Thanks for answering so quickly.

Would acupuncture do the same as trigger point injections?

How do we know if it is scar tissue? Danny had a MRI of neck and upper back last month which was normal.

He has terrible pain in his shoulder blade (on the back) not joint and also his neck. His movement in the neck is limited. Can't bend neck down. Sleeping is a great challenge because the pain seems to be the worse at night.

He had an appointment to get a cortisone shot, but cancelled it. Maybe trigger point injections could work for him. He is afraid to get too many cortisone shots. He has already had 4 in his lower back, but that was over a year ago. Due to the NS/ND diet, which he has been on for 3 months now, his lower back has gotten some relief. Now we need to get the top half of the back to respond!

We will have to try ice. Haven't tried that yet. Great suggestion.

Laurie

oh, i know how bad all this can be.

i've never tried acupuncture because the ultrasound from the physical therapist office and now sometimes from the chiropractor's office, and the trigger point injections by the physiatrist worked so well.

i've heard and read that acupuncture may work by a similar principle, but i don't have the experience with it.

my trigger points as dx'ed by PT and physiatrist caused lots of muscle spasms so treating the muscle spasms directly helps. if he notices temporary
relief in the shower or in a bath, then the pain could be largely / partly from muscle spasms. for me, heat works as its used, but as soon as its taken off, the spasms start right back up. ice seems to keep the muscle spasms at bay longer. also the ice works directly on my triggerpoints as well, just not as well as the ultrasound, and the ultrasound isn't as effective as the tp injections. the physiatrist also prescribed the muscle relaxant zanaflex and i take that every night at bedtime, and during the day if i have to, though it
makes me too drowsy for an hour to be able to function on it at that time.
and i found laying on my back with a flat feather pillow for my head to keep the neck perfectly neutral was essential, or i get an inflamed occipital muscle and the headaches to go along with it.

but even with all of that going on. as long as i don't travel and don't sit in the wrong seat, my back and neck are pretty good.

i kind of fell into the physiatrist in virginia, PT recommended her.

but when i moved to upstate NY in 2003, i looked at pain management specialists and physiatrists and called and asked specifically who routinely did trigger point injections since they worked so well in virginia. and only a few doctors said they did them routinely. i loved my physiatrist in virginia and i love my current physiatrist. they are the main ones who have been able to get my symptoms under control and give me my life back....

sue