Left Chest and Upper Back Pain: Causes and When to See a Doctor

Pain in the left anterior chest and upper back?

In recent days, I have experienced pain when pressing below the underwire of my left bra, along with pain in the upper left back.
There are no lumps or swelling.
What could be the cause? Which department should I visit for medical consultation? Thank you.

Afan, 30~39 year old female. Ask Date: 2017/04/10

Dr. Chen Taicheng reply Family Medicine

● Considering your age, the likelihood of cardiovascular diseases or severe pulmonary conditions is low.
The pain in your left chest and upper back is more likely to be musculoskeletal or gastrointestinal in nature.
● Excerpting from my previous article, which addresses issues similar to yours for your reference (https://goo.gl/53ePqq): "The more probable causes of left upper back pain include peptic ulcers (such as gastric ulcers), pancreatitis (often related to alcohol consumption or high cholesterol), urinary tract stones (such as left kidney stones), and pulmonary issues (such as ischemic heart disease, which is less common at your age), aortic dilation or dissection, pneumonia, and other lung diseases." ● Given your situation, it is important to first consider whether discomfort may be caused by ill-fitting undergarments or tight underwire, which could lead to localized tenderness and inflammation of the surrounding fascia.
I recommend consulting with a family medicine physician, gastroenterologist, or pulmonologist for further evaluation to identify the source of tenderness and related symptoms.
If necessary, a chest X-ray or consideration of gastrointestinal medications and muscle pain relievers may help alleviate the issue.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/04/10

More Info

Understanding left chest and upper back pain can be quite complex, as there are numerous potential causes ranging from musculoskeletal issues to more serious conditions. Given your description of pain located beneath the underwire of your bra and in the upper back, it is essential to consider various factors that could contribute to these symptoms.

Possible Causes of Left Chest and Upper Back Pain
1. Musculoskeletal Issues:
- Muscle Strain: Overuse or strain of the muscles in the upper back or chest can lead to localized pain. This can occur from poor posture, repetitive movements, or even sleeping in an awkward position.

- Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum can cause sharp pain in the chest area, which may radiate to the back.

- Intercostal Muscle Strain: The muscles between the ribs can become strained, leading to pain that may be felt in both the chest and back.

2. Nerve-Related Issues:
- Nerve Compression: Conditions such as a herniated disc in the cervical or thoracic spine can compress nerves, leading to pain that radiates to the chest and upper back.

- Thoracic Outlet Syndrome: This occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed, leading to pain in the shoulder, neck, and upper back.

3. Cardiac Concerns:
- While your symptoms may not immediately suggest a cardiac issue, it is crucial to rule out conditions such as angina or myocardial infarction, especially if you experience additional symptoms like shortness of breath, sweating, or radiating pain to the arm or jaw.

4. Gastrointestinal Issues:
- Gastroesophageal Reflux Disease (GERD): Acid reflux can cause chest pain that may be mistaken for cardiac pain. It can also lead to discomfort in the upper back.

- Esophageal Spasms: These can cause severe chest pain that may radiate to the back.

5. Psychological Factors:
- Stress and anxiety can manifest as physical pain, including in the chest and back areas.

When to See a Doctor
Given the nature of your symptoms, it is advisable to seek medical attention if:
- The pain persists for more than a few days without improvement.

- You experience any additional symptoms such as shortness of breath, dizziness, or radiating pain to the arms or jaw.

- The pain worsens or changes in character (e.g., becoming more intense or spreading).

Which Specialist to Consult
For your symptoms, starting with a visit to a primary care physician or a family doctor would be appropriate. They can perform a thorough evaluation, including a physical examination and possibly imaging studies (like X-rays or MRIs) if necessary. If musculoskeletal issues are suspected, they may refer you to a physiatrist (rehabilitation specialist) or an orthopedic doctor. If there are concerns about cardiac issues, a referral to a cardiologist may be warranted.

Conclusion
In summary, while there are many potential causes for left chest and upper back pain, it is crucial to monitor your symptoms closely. If the pain persists or worsens, do not hesitate to seek medical advice. Early intervention can help identify the underlying cause and facilitate appropriate treatment, ensuring your health and well-being.

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