Discomfort in the Shoulder Blade
I'm a Caucasian male, standing at 5 feet 10 inches and weighing 235 pounds. I do not smoke, consume alcohol, or use drugs. For the past three years, I've been consistent with my workouts, hitting the gym four to five times a week. Over the past week, I've been experiencing an unusual discomfort around my shoulder blade. This pain occasionally radiates to other areas, including my chest. Unfortunately, my condition hasn’t improved during this time; it has remained fairly consistent, peaking on the third day. Concerned, I visited urgent care where my EKG results were normal. Subsequently, I was referred to the emergency room, but they primarily focused on evaluating my kidneys through a blood test, which returned normal results. Strangely, they did not perform any heart tests, CT scans, or additional assessments. I’m left puzzled; do they genuinely believe it’s just a minor back injury, or did they simply want to dismiss me without adequate treatment? What should I consider as my next course of action? I’m happy to provide further information if needed. On the morning of the peak discomfort, I decided to go to the gym and had a back workout (which I now regret). However, during and immediately after exercising, I felt relief from the pain, leading me to question whether this is indeed a muscular issue. The most intense pain struck around 2 AM, preventing me from sleeping due to the discomfort radiating across my back. I returned to the ER where I received a pain relief injection in my arm; about an hour later, the pain subsided significantly, localizing back to its original point. This sensation feels different from any muscle pain I’ve previously experienced and seems to originate internally. Additionally, I notice discomfort when I take deep breaths, as if there’s something forcing against my lungs.
Answers (1)
7/6/2025, 9:30:45 PM
OpenHealth AI
It's great that you're actively seeking clarity about your discomfort. Given your symptoms and the investigations you've undergone, it’s understandable to feel puzzled about the cause of your shoulder blade pain, especially with the radiating discomfort and its interference with sleep.
Summary of Key Points:
- Your symptoms, such as the shoulder blade discomfort radiating to the chest and deep breathing pain, could stem from various issues involving muscles, nerves, or possibly other internal structures.
- The normal EKG and kidney tests are reassuring but do not rule out all possible causes.
- The fact you experienced pain relief post-exercise suggests it might be musculoskeletal, yet your specific sensations warrant further evaluation.
Explanation:
Discomfort in the shoulder blade region can arise from several sources:
- Musculoskeletal Origin: This could include muscle strain, irritation of nerves, or even issues related to posture, especially considering your workout routine.
- Referred Pain: Your pain could be referred from another area, such as the heart or lungs, although less likely given your normal tests.
- Internal Issues: Since you mentioned discomfort when breathing deeply, it may be worthwhile to consider additional evaluations for lung-related issues or any internal muscular issues.
Next Steps:
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Continue Monitoring Symptoms: Keep track of when the pain worsens or improves, especially concerning any physical activity. Take note if it changes with posture, breathing, or activity.
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Modify Physical Activity: While you felt some relief when working out, pay attention to how your body responds. Consider lighter exercises focusing on flexibility, stretching, and core strengthening instead of heavy lifting until you have clarity on the underlying issue.
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Pain Management Techniques:
- Rest: Ensure to give your muscles some time to recover. Avoid activities that exacerbate the pain.
- Heat/Ice Therapy: Apply heat or ice packs on the affected area to alleviate discomfort.
- Over-the-Counter Pain Relief: Consider using NSAIDs (like ibuprofen or naproxen) as directed, unless contraindicated for you.
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Follow-Up Care:
- Request Further Evaluation: Given your ongoing concerns, consider reaching out to your primary care provider or a specialist (like an orthopedic or neurologist) for a thorough examination including possible imaging studies (like an MRI or ultrasound).
- Ask for Referral to Physical Therapy: A physical therapist can assess your mobility and strength, suggest exercises, and potentially identify contributing factors to your pain.
Please remember to listen to your body and prioritize your comfort and well-being. If symptoms significantly worsen (like increased chest pain, difficulty breathing, or new symptoms), seek immediate medical attention.
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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.