Pain Between the Clavicles: When to See an Orthopedic Specialist

Tenderness in the intercostal spaces?

Hello Dr.
Chen: I often experience pain about 2 centimeters below the midpoint of my clavicles after changing positions.
When I press on those two points during the pain, it hurts.
This symptom has been persistent for a long time, with episodes of improvement and worsening.
I have consulted a pulmonologist, and X-rays showed no issues.
What should I do? Should I see an orthopedic specialist? What could be causing the pain? Thank you, doctor!

Ariel, 20~29 year old female. Ask Date: 2016/04/14

Dr. Chen Yongxue reply Orthopedics

Hello, this may be related to your daily habits.
Generally, jobs that require prolonged fixed positions (such as working at a computer or gaming) are more likely to lead to discomfort.
When pain points occur, you can apply heat therapy or massage.
If the condition worsens, you may consider taking some pain relievers.
Additionally, I recommend developing a regular exercise routine, as this can help alleviate many muscle discomforts caused by work or lifestyle habits without the need for medication.
Thank you.

Reply Date: 2016/04/14

More Info

Hello! Thank you for your question regarding the pain between your clavicles. Based on your description, it sounds like you are experiencing discomfort in the area just below the clavicles, which can be quite bothersome. Given that you have already consulted a thoracic specialist and had X-rays that did not reveal any issues, it’s understandable to feel uncertain about the next steps.

First, let's explore the potential causes of pain in the area between the clavicles. This region is known as the supraclavicular area, and pain here can arise from various sources, including:
1. Musculoskeletal Issues: The pain you are experiencing could be related to muscle strain or tension in the muscles surrounding the clavicles, such as the sternocleidomastoid or trapezius muscles. Poor posture, repetitive movements, or even stress can lead to muscle tightness and discomfort.

2. Nerve Compression: The brachial plexus, a network of nerves that innervates the arm, runs near the clavicles. Compression or irritation of these nerves can lead to pain that may radiate to the shoulder or arm.

3. Joint Problems: Issues with the sternoclavicular joint (where the clavicle meets the sternum) or the acromioclavicular joint (where the clavicle meets the shoulder) can also cause pain in this area. Conditions such as arthritis or joint inflammation could be contributing factors.

4. Referred Pain: Sometimes, pain in the supraclavicular area can be referred from other regions, such as the neck or upper back. Conditions like cervical radiculopathy or thoracic outlet syndrome may manifest as pain in this area.

Given that your symptoms have persisted for a long time and fluctuate in intensity, it may be beneficial to see an orthopedic specialist. An orthopedic doctor can conduct a thorough physical examination, assess your range of motion, and possibly order additional imaging studies, such as an MRI or CT scan, to evaluate soft tissue structures that X-rays may not adequately reveal.

In addition to consulting an orthopedic specialist, consider the following steps to manage your symptoms:
- Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the clavicles, improve posture, and alleviate tension. A physical therapist can provide tailored exercises and techniques to address your specific pain.

- Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may help reduce inflammation and alleviate pain. However, it’s essential to consult with a healthcare provider before starting any medication.

- Posture and Ergonomics: Assess your daily activities and posture. If you spend long hours sitting or working at a desk, ensure that your workstation is ergonomically designed to minimize strain on your neck and shoulders.

- Stress Management: Since stress can contribute to muscle tension, incorporating relaxation techniques such as deep breathing, yoga, or meditation may help reduce discomfort.

In conclusion, while your symptoms may not have shown clear abnormalities on X-rays, it is still crucial to pursue further evaluation, especially if the pain persists or worsens. An orthopedic specialist can provide a comprehensive assessment and guide you toward appropriate treatment options. Don’t hesitate to seek a second opinion if you feel it’s necessary, as different practitioners may offer various insights and approaches to your condition. Wishing you relief and a swift resolution to your discomfort!

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