Left Chest and Back Pain: Causes and Concerns

Shoulder, back, and chest pain?

Hello Doctor, about six months ago, I started experiencing a dull pain in the left side of my chest when I inhale.
Initially, I thought it was just psychological and didn't pay much attention to it, but over time, it hasn't improved and the symptoms have increased.
I often feel a dull pain that radiates to my back, but there are no specific tender points when I press on my back.
I also feel a vague pain when I change positions due to stretching, but it's bearable.
This pain feels similar to that of a stiff neck; it seems that any movement of my shoulder triggers a pulling pain from my chest to my back, although it's not as intense as a stiff neck.
Sometimes, it seems to ease a bit, but I still feel something is off when I move.
Since last week, the pain seems to have extended to my armpit and shoulder, meaning that whenever I cough, twist my left shoulder, or take a deep breath, I feel discomfort and a dull ache in those areas.
I'm wondering if you think this is a serious issue and what areas might be affected.
Additionally, while researching, I found that lung cancer can also present with shoulder and neck pain.
Should I be concerned about the severity of this? Thank you for your clarification!

Yan Yan, 30~39 year old female. Ask Date: 2017/11/25

Dr. Li Yongheng reply Orthopedics

Hello, if you have been experiencing shoulder, back, and chest pain for six months, which fluctuates in intensity, it is usually due to poor posture or work-related intercostal muscle strain or inflammation.
However, it is still recommended that you consult a pulmonologist and undergo a chest X-ray to rule out any lung or heart conditions (such as mitral valve prolapse).
Wishing you a speedy recovery.

Reply Date: 2017/11/25

More Info

It sounds like you have been experiencing a complex set of symptoms involving left chest and back pain, which has been progressively worsening over the past six months. The pain you describe as a dull ache that radiates from the chest to the back, and even to the shoulder and armpit, can be concerning, especially when it is associated with movements like deep breathing or coughing.

Potential Causes of Your Symptoms
1. Musculoskeletal Issues: Given your description of the pain being triggered by movement and the sensation of tightness, it is possible that you are dealing with a musculoskeletal issue. This could include muscle strain, ligament sprain, or even a condition like costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum. These conditions can cause localized pain that may radiate to other areas.

2. Nerve Impingement: Another possibility is that a nerve in your neck or upper back is being compressed or irritated. This can lead to referred pain that travels down the arm or into the chest. Conditions such as cervical radiculopathy could be responsible for the symptoms you are experiencing.

3. Referred Pain from Internal Organs: While less common, it is also important to consider that pain in the chest and back can sometimes be referred from internal organs. For example, issues related to the heart, lungs, or even the gastrointestinal tract can manifest as pain in these areas. Given your history of mild gastroesophageal reflux disease (GERD), it is conceivable that this could be contributing to your symptoms.

4. Anxiety and Stress: Psychological factors can also play a significant role in the perception of pain. Anxiety can lead to muscle tension and exacerbate pain sensations, particularly in the chest and back.

5. Serious Conditions: While it is less likely given your age and overall health, serious conditions such as lung cancer or other malignancies can present with similar symptoms. However, these are typically accompanied by other signs such as weight loss, persistent cough, or changes in appetite.

When to Seek Further Evaluation
Given the persistence and progression of your symptoms, it is advisable to seek further evaluation from a healthcare professional. Here are some steps you might consider:
- Consult a Primary Care Physician: A thorough examination, including a detailed history and physical examination, is essential. Your doctor may perform tests such as X-rays, MRI, or CT scans to rule out structural issues.

- Cardiac Evaluation: Although you mentioned no history of hypertension or other risk factors, it may still be prudent to have a cardiac evaluation to rule out any underlying heart issues, especially if you experience any new symptoms like shortness of breath, palpitations, or significant fatigue.

- Pulmonary Assessment: If there are concerns regarding lung issues, a chest X-ray or CT scan may be warranted to evaluate for any abnormalities.

- Musculoskeletal Assessment: If musculoskeletal issues are suspected, physical therapy may be recommended to strengthen the muscles and improve posture, which can alleviate pain.

Conclusion
In summary, while your symptoms could be related to musculoskeletal issues, nerve impingement, or even referred pain from internal organs, it is crucial to have a comprehensive evaluation to rule out any serious conditions. Given the complexity of your symptoms, a multidisciplinary approach involving your primary care physician, possibly a cardiologist, and a physical therapist may be beneficial. Do not hesitate to seek medical attention, especially if your symptoms worsen or new symptoms arise. Your health and peace of mind are paramount, and addressing these concerns early can lead to better outcomes.

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