Chronic Rib and Shoulder Blade Pain: What Specialist Should You See?

Pain in the left and right ribs, pain in the scapula?

Doctor: Why do I have rib pain every day, and it has been persistent? I had an X-ray done and visited a family medicine clinic where I was prescribed medication twice.
The first medication worked, but after finishing it, the pain returned.
The second medication didn't have much effect, and I still feel pain.
Which specialty should I see? Is there an issue with my bones? Why does it hurt every day for such a long time? Sometimes I feel a dull pain on both sides, and at times the pain in my bones is very intense! Which specialist would be most helpful for me? The pandemic makes me hesitant to go to the hospital blindly!

Lin Xin-Yi, 40~49 year old female. Ask Date: 2022/02/13

Dr. You Dianqi reply Orthopedics

It is recommended to first visit the orthopedic or pulmonology department at the hospital for an examination and arrange for some imaging studies, such as X-rays or bone scans.
This will help differentiate whether the issue is intrathoracic (such as pneumonia or pleuritis) or extrathoracic (such as rib or intercostal muscle problems), or if it is referred pain (like the scapular pain you mentioned, which may also require consideration of cervical spine pathology).
Thank you, and I wish you a speedy recovery.

Reply Date: 2022/02/13

More Info

Chronic rib and shoulder blade pain can be quite distressing, and it’s understandable that you’re seeking clarity on which specialist to consult for your ongoing discomfort. Given the complexity of your symptoms, it’s essential to approach this systematically.

Firstly, it’s important to recognize that rib and shoulder blade pain can stem from various causes, including musculoskeletal issues, nerve impingement, or even referred pain from internal organs. Since you’ve already undergone X-rays and have seen a family physician without significant improvement, it may be time to consider consulting a specialist who can provide a more targeted approach to your condition.

1. Orthopedic Specialist: An orthopedic doctor specializes in the musculoskeletal system, which includes bones, joints, ligaments, tendons, and muscles. They can evaluate your rib and shoulder blade pain, assess for any structural abnormalities, and determine if there are issues such as fractures, arthritis, or tendon injuries. Given that you have persistent pain, an orthopedic evaluation may help identify any underlying conditions that could be contributing to your discomfort.

2. Physical Medicine and Rehabilitation (PM&R) Specialist: Also known as physiatrists, these specialists focus on restoring function and improving quality of life for patients with musculoskeletal issues. They can provide a comprehensive evaluation and develop a rehabilitation plan that may include physical therapy, pain management techniques, and lifestyle modifications.

3. Pain Management Specialist: If your pain is chronic and not responding to typical treatments, a pain management specialist may be beneficial. They can offer advanced pain management techniques, including injections, nerve blocks, or other interventions that target the source of your pain.

4. Rheumatologist: If there’s a suspicion of an underlying inflammatory or autoimmune condition (such as rheumatoid arthritis or fibromyalgia), a rheumatologist may be the appropriate specialist to consult. They can perform specific tests to rule out these conditions and provide treatment options if necessary.

5. Neurologist: If your pain is accompanied by symptoms such as numbness, tingling, or weakness, it may indicate nerve involvement. A neurologist can assess for conditions like thoracic outlet syndrome or cervical radiculopathy, which can cause referred pain to the shoulder and rib area.

In addition to seeing a specialist, consider the following steps to manage your pain:
- Physical Therapy: Engaging in physical therapy can help strengthen the muscles around your shoulder and rib cage, improve flexibility, and alleviate pain. A physical therapist can design a personalized exercise program tailored to your needs.

- Pain Management Techniques: Techniques such as heat therapy, cold packs, or over-the-counter pain relievers (like NSAIDs) may provide temporary relief. However, it’s crucial to consult with a healthcare provider before starting any new medication.

- Lifestyle Modifications: Evaluate your daily activities and posture. Poor ergonomics, especially if you spend long hours sitting or working at a computer, can contribute to musculoskeletal pain. Adjusting your workstation and incorporating regular breaks for stretching can be beneficial.

- Mind-Body Techniques: Practices such as yoga, meditation, or mindfulness can help manage chronic pain by reducing stress and improving overall well-being.

In summary, given your chronic rib and shoulder blade pain, starting with an orthopedic specialist or a physical medicine and rehabilitation specialist would be a prudent choice. They can conduct a thorough evaluation, recommend appropriate imaging if needed, and develop a comprehensive treatment plan tailored to your specific condition. Remember, it’s essential to communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the best possible care.

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