Chest Pain

Is this your child’s symptom?

• Pain or discomfort in the chest (front or back)
• The chest includes from the top to the bottom of the rib cage

Causes of Chest Pain

• Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders.
• Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome.
• Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.
• Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing.
• Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone).
• Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well.
• Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture.
• Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause.
• Pleurisy (Serious). Pleurisy is another problem of pneumonia. If the infection involves the lung’s surface, that area of the chest will hurt.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Chest Pain

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Passed out (fainted)
• Bluish lips or face
• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Your child has heart disease
• Trouble breathing, but not severe
• Taking a deep breath makes the pain worse
• Heart is beating very rapidly
• After a direct blow to the chest
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Fever is present
• Cause of chest pain is not clear. Exception: pain due to coughing, sore muscles, heartburn or other clear cause.
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Chest pains only occur with hard exercise (such as running)
• Sore muscles last more than 7 days
• Heartburn lasts more than 2 days on treatment
• Chest pains are a frequent problem
• You have other questions or concerns

Self Care at Home

• Normal chest pain from sore muscles
• Normal chest pain from heartburn

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Sore Muscle Pain Treatment

1. What You Should Know About Mild Chest Pain:
   • Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment.
   • Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
   • Continue this until 24 hours have passed without pain.
3. Cold Pack for Pain:
   • For the first 2 days, use a cold pack to help with the pain.
   • You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes, then as needed.
   • Caution: avoid frostbite.
4. Use Heat After 48 Hours:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Reason: increase blood flow and improve healing.
   • Caution: avoid burns.
   • A hot shower may also help.
5. Stretching the Muscles:
   • Gentle stretching of the shoulders and chest wall may help.
   • Do sets of 10 twice daily.
   • This may prevent muscle cramps from coming back.
   • Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain.
6. What to Expect:
   • For sore muscles, the pain most often peaks on day 2.
   • It can last up to 6 or 7 days.
7. Call Your Doctor If:
   • Pain becomes severe
   • Pain lasts over 7 days on treatment
   • You think your child needs to be seen
   • Your child becomes worse

Heartburn (Reflux) Pain Treatment

1. What You Should Know About Heartburn:
   • Heartburn is common.
   • It’s due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach.
   • Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching.
   • Here is some care advice that should help.
2. Antacids:
   • Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed.
   • Dose: give 1 to 2 tablespoons (15 – 30 mL).
   • If you don’t have an antacid, use 2 to 3 ounces (60 – 90 mL) of milk.
   • For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days.
3. Heartburn Prevention:
   • Do not eat too much at meals. This overfills the stomach.
   • Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine.
   • Do not bend over during the 3 hours after meals.
   • Do not wear tight clothing or belts around the waist.
4. What to Expect:
   • Most often, heartburn goes away with treatment.
   • But, heartburn also tends to come back. So, preventive measures are important.
5. Call Your Doctor If:
   • Heartburn doesn’t go away after 2 days of treatment
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Pain Under Right Breast | FastMed Urgent Care

Breast cancer is quite common among American women, so when breast pain occurs, it can be alarming. Let us put you at ease, however, because tenderness or pain in under the right breast is not always a sign of a serious problem. In fact, breast pain is not usually a sign of breast cancer.

If you are experiencing pain under your right breast, don’t panic–just come to FastMed. We provide treatment for injuries and illnesses that don’t require a trip to the emergency room.

Pain under Your Right Breast?

So, what could be causing that pain under the right breast?

• Puberty in girls (and sometimes boys)
• Menstruation and premenstrual syndrome (PMS)
• Pregnancy
• Days following childbirth
• Menopause

If the pain under your right breast is affecting your chest more than the breast itself, it could be caused by other conditions, such as indigestion or gall bladder infection. Indigestion can, due to acid refluxes, cause a burning sensation in the right side of your chest. Gallbladder infections are caused by an inflammation of the gallbladder and typically cause a sharp pain the stomach or right side of the chest.

Come to FastMed if you are experiencing pain under your right breast along with any of the following symptoms:

• Bloody or clear nipple discharge
• Persistent, unexplained breast pain
• Signs of a breast infection (local redness, pus, or fever)
• A new lump with the onset of pain
• Pain could be due to indigestion or gallbladder troubles

If you are experiencing pain under your right breast, it is important to seek medical attention as soon as possible and determine the cause. Early diagnosis of pain under your right breast can prevent the development of more serious complications.

FastMed walk-in clinics are open with extended hours 365 days a year. We are a fast, affordable, and reliable alternative to the emergency room when non-life-threatening illnesses or injuries strike.

Chest pain | nidirect

Chest pain can be caused by anything from muscle pain to a heart attack and should never be ignored.

When to get immediate help 

It is important to try to identify if the cause is serious or life threatening. The information below should not be used to self-diagnose your condition.

It should give you an idea of what is causing your chest pain and whether you need to get emergency help or see your GP. It does not include every possible cause, but describes the most common reasons for chest pain.

You should call 999 for an ambulance immediately if you develop sudden severe chest pain, particularly if:

• the pain is central or band-like and feels heavy, pressing or tight
• the pain lasts longer than 15 minutes
• the pain spreads to other parts of your body, such as your arms, back or jaw
• you also have other symptoms, such as breathlessness, nausea, sweating, or coughing up blood
• you are at risk of coronary heart disease – for example, you smoke, are obese, or have high blood pressure, diabetes or high cholesterol

If you think you could be having a heart attack, call 999 immediately and ask for an ambulance. Do not worry if you have any doubts about whether it is a heart attack. Paramedics would prefer to be called out to find that an honest mistake has been made than to be called out when it is too late to save a person’s life.

If the discomfort is not sudden and severe, or has resolved, it may be more appropriate to see your GP.  If your own GP surgery is closed, you should contact your local out of hours service if you are concerned and need advice as to whether you need assessment or treatment.

Heart problem

Chest pain is often a problem that is not caused by a heart condition. Chest pain related to a heart problem is commonly caused by:

• angina – where the blood supply to the muscles of the heart is restricted
• a heart attack – where the blood supply to part of the heart is suddenly blocked

Both of these conditions can cause a dull, heavy or tight pain in the chest that is central, or band-like; the pain can spread to the arms, neck, jaw or back. They can also cause additional symptoms, such as breathlessness, nausea, paleness and sweating.

The main differences between these conditions is that chest pain caused by angina tends to be triggered by physical activity or emotional stress, and gets better with rest after a few minutes.

If you have previously been diagnosed with angina, the pain may also be relieved by your angina medication.

Symptoms that last more than 15 minutes, occur at rest, and include sweating and vomiting are more likely to be caused by a heart attack.

Dial 999 immediately to request an ambulance if you think you or someone else is having a heart attack, or if you have the symptoms above and haven’t been diagnosed with a heart condition.

If you have an angina attack and you’ve previously been diagnosed with the condition, take the medication prescribed for you. A second dose can be taken after five minutes if the first dose is ineffective.

If there is no improvement five minutes after the second dose, call 999 and ask for an ambulance.

Common causes of chest pain 

Most chest pain is not heart-related and isn’t a sign of a life-threatening problem. Some common causes of chest pain are outlined below.

This information should give you an idea of whether these conditions may be causing your chest pain. However, see your GP for a proper diagnosis and for advice about how to relieve the pain and tackle any underlying cause.

Gastro-oesophageal reflux disease (GORD) 

Gastro-oesophageal reflux disease (GORD) is a common condition where acid from the stomach comes up into the oesophagus (gullet).

Common symptoms of GORD include:

• burning upper abdominal discomfort or pain/chest pain (heartburn) which may sometimes be difficult to differentiate from a heart problem without clinical assessment
• an unpleasant taste in the mouth caused by stomach acid coming back up into your mouth
• symptoms are usually improved by antacids and may be relieved, or worsened, by food

These symptoms usually occur soon after you’ve eaten and get worse if you bend over or lie down.

GORD can often be treated by making lifestyle changes and, if necessary, using medication.

Bone or muscle problems 

If your chest is painful and tender to touch, it may be caused by a strained muscle in your chest wall. This can be surprisingly painful, but with rest the pain should ease and the muscle will heal in time.

If you have pain, swelling and tenderness around your ribs, and the pain is made worse by lying down, breathing deeply, coughing or sneezing, you may have a condition called costochondritis.   

This is caused by inflammation in the joints between the cartilage that joins the ribs to the breastbone (sternum). The symptoms often improve after a few weeks and may be relieved by painkillers.

Anxiety and panic attacks 

Some episodes of chest pain occur as part of an anxiety or panic attack.

In addition to chest pain and overwhelming feelings of anxiety, these attacks can cause symptoms such as heart palpitations, sweating, breathlessness and dizziness.

Most panic attacks last for 5 to 20 minutes. In the long-term, you may benefit from psychological therapy and medication, or both.

Lung conditions 

If you have sharp chest pain that gets worse when you breathe in and out, and is accompanied by other symptoms such as a cough and breathlessness, it may be caused by a condition affecting the lungs or surrounding tissue, such as:

• pneumonia – inflammation of the lungs, usually caused by an infection
• pleurisy – inflammation of the membrane surrounding the lungs, also usually caused by an infection

Mild cases of pneumonia can usually be treated with antibiotics, rest and fluids. For people with other health conditions, the condition can be severe and they may need to be treated in hospital.

Treatment for pleurisy will depend on the underlying cause. Pleurisy caused by a viral infection will often resolve without needing treatment. Pleurisy caused by a bacterial infection will usually need to be treated with antibiotics.

Again, people who are frail or already in poor health may need to be admitted to hospital for treatment.

Other possible causes 

There are many other potential causes of chest pain, including:

• shingles – a viral infection of a nerve and the area of skin around it, which causes a painful rash that develops into itchy blisters
• mastitis – pain and swelling of the breast, which is usually caused by an infection, most commonly during breastfeeding
• acute cholecystitis – inflammation of the gallbladder, which can cause a sudden sharp pain in the upper right side of your tummy that spreads towards your right shoulder
• stomach ulcers – a break in the lining of the stomach, which can cause a burning or gnawing pain in your tummy
• a pulmonary embolism – a blockage in the blood vessel that carries blood from the heart to the lungs, which can cause sharp, stabbing chest pain that may be worse when you breathe in, as well as breathlessness, a cough, coughing up blood and dizziness: if your symptoms are particularly severe, dial 999 immediately and ask for an ambulance.
• pericarditis– inflammation of the sac surrounding your heart, which can cause a sudden, sharp and stabbing pain in your chest, or more of a dull ache; the pain usually worsens when lying down

Some of these conditions can be very serious. Make sure you seek medical advice so you can be correctly diagnosed and treated.

More useful links

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

Bruised Sternum & Sternum Fracture

A bruised sternum is caused by direct trauma, or impact to the sternum bone in the middle of the chest. In more severe cases, a fracture may occur, or dislocation of the sternoclavicular joint. Here we explain the symptoms, causes and treatment for sternum injuries.

Bruised sternum

Sternum fracture

Bruised sternum

A bruised sternum, or sternum contusion as it is also known, occurs after an impact to the sternum or breastbone. This most frequently occurs after road traffic accidents, although collision sports and those with hard balls or rackets etc can also impact the sternum.

Symptoms of a bruised sternum

• Symptoms include pain on the breastbone following impact.
• You will feel tenderness at the front of the chest over the bone and breathing may be painful.
• Coughing and sneezing are also likely to reproduce pain and bruising may appear later.

Treatment for a bruised sternum

If the pain is severe seek medical attention as soon as possible. A doctor will perform a full examination and may order X-rays which can confirm that there are no fractures to the sternum or the ribs. Treatment of a bruised sternum requires rest for 2-4 weeks to allow the bone to heal. Ice and anti-inflammatory medication may be advised by the doctor to help ease pain and inflammation.

Sternum fracture

A sternum fracture is a break to the breastbone. A sternal fracture is most often caused by a direct impact to the bone, at the front of the chest.

This is most frequent in road traffic accidents. There will be sharp chest pain at the front of the body and bruising may appear. The injury will need to be assessed and monitored to ensure no further damage is made.

Sternum fracture symptoms

• Symptoms of a fractured sternum include a sudden onset of pain at the front of the chest after an impact or fall of some kind.
• Pain is usually well localised and does not radiate.
• It will be very tender to touch the fracture area and bruising may start to appear after a few hours.
• Up to 20% of patients may demonstrate breathing difficulties.

Causes

Fractured sternums most frequently occur during road traffic accidents. A fractured sternum may also occur during chest compression as performed during CPR (cardiopulmonary resuscitation). Fractures of the breastbone may also happen with considerably less force and have been seen in golfers and weightlifters previously. Older people with Osteoporosis may also be more at risk.

Whilst a fracture is a common injury which is often straightforward to treat, a sternal fracture should be examined thoroughly and put under observation for other complications. These may include pulmonary and cardiac contusions (bruising of the lungs or heart) or damage to the aorta (main artery from the heart). If the fractured part of the bone has been displaced, this is more likely to cause further complications.

Treatment

Treatment of a sternum fracture which has not been displaced generally involves rest and the use of painkillers or anti-inflammatory medications.

If the bone fragment has become displaced, a surgical procedure may be required to re-align the two bone pieces and possibly fix them with pins or screws.

More on chest pain and injuries:

A breast contusion is bruising of the breast tissue, caused by a direct impact to the area. Common examples of this are being hit by…

Jogger’s nipple is in effect a friction burn. It is caused by constant rubbing or chafing of a T-shirt over the nipple. Jogger’s nipple symptoms…

Cardiac Chest Pain In Athletes

Chest pain in athletes can be from a number of causes. Thankfully, cardiac chest pain in athletes is rare. A range of conditions causes pain…

Jogger’s breasts is a result of Repetitive trauma from jogging. It causes permanent damage resulting in breasts dropping. Not wearing a supportive bra when exercising…

Collapsed Lung or Pneumothorax

A collapsed lung is also known as a pneumothorax. It occurs when there is a build-up of air in the space between the lungs and…

Costochondritis (Tietze’s Syndrome)

Costochondritis is also referred to as Tietze’s syndrome. It is a painful condition that occurs at the joints between the ribs and the sternum (breastbone).…

This article has been written with reference to the bibliography.

MY COVID Story: I thought my chest pain and breathlessness was due to a muscle pull

Dr Mansi Sharma experienced acute chest pain and got an X-ray done, which showed she was COVID positive. While the COVID test gave a negative test, she stayed isolated with her mother who was also COVID positive. Here is her COVID journey

It was a normal day, a light winter morning. I woke up after getting scolded by my dad for sleeping till 9:30 am.

I decided to consult a physician as I had a slight pain in my sternum area. Well, it was not exactly a pain but certain heaviness – I had fallen in the bathroom back in May and I was concerned if this heaviness that was turning severe was anyhow linked to it. My doctor prescribed some 3-4 tests and by evening that day I had my reports and I started the treatment.

I also decided to consult my pulmonologist once and he advised me to go for a chest X ray. While I got my chest X ray done but I delayed visiting him since I was feeling completely healthy and was anyway continuing with my medication.

Soon I got busy with my Diwali preparations. It was the weekend and my sister and niece were coming for the weekend. I was very excited to meet them as they were coming almost after a month as my sister had tested COVID positive a month back.

I cleaned up my room, washed my windows and singlehandedly shifted my bed as I didn’t want to trouble my parents (they are both 60 plus). My sister came and we had a good time. Next morning i.e on 8th of November I woke up and was feeling a slight difficulty in breathing. I was an asthmatic but I had taken my complete treatment 6-7 years back from Dr. Rajnish Sharma who is a senior pulmonologist. Thanks to him I had not used a nebuliser even once in the past 6 years. He was the one who had adviced me to go for a chest X ray.

That morning I took my nebuliser but was still having the same breathing difficulty. The whole area under my chest was paining – I was feeling it even while walking or lying on bed. I was in such a condition that I could not even feel any taste of the food I was eating. So I just took my medication and slept for the whole day. Even while sleeping I could feel the pain.

In the evening, I woke up, had my dinner. My sister was trying her best to distract me so I could take my mind off the pain. Everyone kept on saying that it was happening because I shifted the bed all on my own and I must have had a muscle pull. Honestly, the breathing difficulty was not similar to what I used to feel during asthma attacks. Something was different that day.

That night when I tried to sleep, I just couldn’t, I felt like I was choking. I went to my mother and told her that my chest was paining immensely. She got worried so I told her I was taking a muscle relaxant and I would be fine by the next morning. But the pain I was feeling wo so severe and was different. I put hot water bag the whole night and watched one of my favourite TV shows. I slept around 5 am and woke up because of that pain. Shockingly, my mother started to feel feverish the next morning so we asked her to isolate herself.

My sister went to the bank and her daughter wanted to play with me but the pain wasn’t letting me do anything. So I gave her my mobile and asked her to watch her favourite show Peppa pig and that’s exactly what she wanted .

I put muscle relaxant ointment and wrapped crape bangade around that area and I started to feel better after that. Apart from lying on the bed, I could not do anything else. When my sister came back home, she asked me to bake a pizza for her. I did and everyone enjoyed the taste but I could only taste it faintly. My family kept on telling me that I was overthinking. My mom developed cold and sore throat. That night I slept with the crape bandage.

Next morning I woke up and I asked my dad to take me to my doctor Dr Rajnish Sharma. I saw my chest X ray and said he could spot certain changes; he asked me to go for a hrct test without thinking. He started my COVID course and also asked my mom to start taking the same medication as there were chances she was suffering from the same issue too.

I went for the test and the pain was not of that severity that day and my taste was coming back to normal too. My scan showed score 4 which was a clear indication that I was positive. I was asked to quarantine and the same was recommended for my mom.

We all then went for COVID testing and it was so shocking that I was negative along with my dad, while my mom was positive. I continued isolating since the hrct scan said it was COVID. The next 14 days were quite normal and I did not even have the pain anymore. I spent my 14 days watching Dekha ek khwaab and re living my childhood. It was my favourite show that time and still is. My friends and cousins kept entertaining me top.

My mom was feeling slight weakness and her taste and smell was completely lost. It was Diwali in the next 3 days and I was feeling sad that I would be spending Diwali in isolation. My aunts and uncles were sending lunch, dinner and other stuff we would need. This is the biggest advantage of having a huge joint family.

But I was worried about my dad. Out of fear, we were not even throwing garbage to not make it risky for others.

These 14 days that I spent in the company of my mom were fun, despite our arguments. By the end of the 14th day, we were so desperate to just get out of the room. On the 16th day, we both got tested and were negative! We were out of isolation but we were still taking precautions and wearing a mask while sitting with my dad or entering the kitchen.

I want to tell those who are suffering from COVID, that it depends on your mindset how you take your disease and suffering. Just be positive and believe in God. If you stay positive, you will give out positive vibes, which matters the most when one is not well. If your mind is healthy and positive, your recovery will be faster. For good physical health, it is important to have good mental health. Stay home, take precautions as much as you can and stay safe.

And please also take care of other people you are coming in contact with in your day-to-day life….like sweepers, milk man vegetable seller. If you have any symptoms, please ask everyone to keep a watch those who have come in contact with you . As we are privileged enough by God’s grace, we can have access to the best facilities, but we never know how and when our negligence can turn out to be a disaster for others.


(Representational image used)

Did you fight COVID-19? We want to hear all about it. ETimes Lifestyle is calling all the survivors of COVID to share their stories of survival and hope.

Write to us at [email protected] with ‘My COVID story’ in the subject line.We will publish your experience.

Sternum Pain or Popping in Chest Bone after Heart Surgery?

Earlier we shared some tips on How to Live a Heart Healthy Lifestyle and reduce your risks of developing heart disease. Unfortunately, heart disease is the leading cause of death in the United States for both men and women. The high prevalence of heart disease in the US has made heart surgery one of the most common procedures performed in the US.

We interviewed Dr. Michael Rose to learn more about the specialized procedure he offers to patients suffering from sternal nonunion and instability. This complication occurs in about two to three percent of patients who undergo heart surgery and often goes undiagnosed, leaving many patients feeling hopeless.

What causes sternal nonunion and instability?

During heart surgery, the sternum is split to provide access to the heart. The sternum is wired back together after the surgery to facilitate proper healing. During the healing phase, the wired sternum is vulnerable to the expansion of breathing muscles, which may loosen the wires over time. Too much activity, violent sneezing or coughing before the sternum is completely healed can result in incomplete healing of the two sides of the bone.

If after heart surgery you experience…

• Pain, clicking, popping or grinding in your breastbone
• Unstable feeling in the chest
• The feeling that each side of your rib cage moves separately when breathing

…Then you may have sternal nonunion and instability.

What can be done to treat sternal nonunion and instability?

Chest wall stabilization has been proven to be an effective treatment for this condition. This procedure uses titanium metal plates to bridge the fractured bone and give it the much-needed stability it lacks. Chest wall stabilization has low recurrence and complication rates. In a review of treatments for sternal nonunion and instability in the Annals of Plastic Surgery published in January 2005, all subjects who underwent the above mentioned procedure experienced a successful outcome. The pain was completely resolved in all patients, wounds healed to completion and there was no incidence of subsequent infection.

About the Author: Dr. Michael Rose

Dr. Michael Rose, MD, FACS has been performing Chest Wall Stabilization for over a decade. Nearly 100 percent of his patients have experienced healing of chest wall instability. Double board certified in plastic surgery and general surgery, Dr. Rose specializes in range of procedures, including breast augmentation, tummy tucks, facelifts and liposuction.

Musculoskeletal causes of breast pain

By Renee Kam, IBCLC, Physiotherapist and Breastfeeding Counsellor.

Finding the cause of breast and/or nipple pain can sometimes be tricky and there may be more than one cause. If you’re having trouble with breastfeeding, the sooner you get help, the sooner you can sort out any problems – big or small.

Breast and/or nipple pain during lactation is most commonly related to the actual breastfeeding, for example to poor attachment, a blocked duct, mastitis or nipple infections.

However pain in breastfeeding mothers, as with anyone, can also be musculoskeletal in origin – that is, it may be caused by conditions of the bones, muscles and their attachments eg joints and ligaments. New tasks undertaken when caring for a small baby may increase the risk of a mother developing musculoskeletal pain – perhaps due to poor posture while feeding, staying in the one position for a long time, muscle imbalances, or fatigue or general stresses that can make muscles tighten up.

Musculoskeletal causes may include breast pain referred from:

• the spine eg due to a bulging disc in the upper or middle back compressing a nerve or a problem with the joints between the vertebrae.

• a trigger point in the large chest muscle lying underneath the breast. Trigger points are hyperirritable and hypersensitive spots in a muscle.

• costochondritis – inflammation of the cartilage holding the upper ribs to the breastbone (sternum).

A condition called Thoracic Outlet Syndrome (TOS) can also lead to breast pain. It happens when too much pressure is placed on nerves and vessels that pass between the muscles in the neck. On the affected side, TOS can cause pain (sharp, burning or aching) in the arm, hand, side of the neck, pectoral (eg breast) area, upper back and/or armpit. Tingling can also be present. Other symptoms of TOS include weakness in the hand and arm muscles on the affected side and that hand may be colder.

A physiotherapist, or other trained musculoskeletal therapist, can help work out whether it is likely that your breast pain is musculoskeletal in origin or not and, if so, what treatment may be appropriate.

It is important to seek professional advice if your pain persists. There can be other medical causes of breast pain that could require urgent medical attention.

  The information on this website does not replace advice from your health care providers.

© Australian Breastfeeding Association April 2015

Plastic surgery of the funnel chest deformity in Krasnodar

Funnel-shaped deformation of the chest skeleton (abbreviation – “VDGK”, “shoemaker’s chest”, pectus excavatum “, sunken chest) – a type of skeletal rearrangement of structural elements (sternum and ribs) of the chest wall, resulting in a” depression “in the sternum [ one]. The deformation demonstrates a different type and depth of “depression” of the sternum and cartilaginous segments of the ribs, which leads to a regression of the chest volume, compression and deviation of the mediastinal organs (primarily the heart, esophagus, airways), which to some extent creates prerequisites for dysfunction of the heart, lungs, manifested in varying degrees of severity and cosmetic defects [2].

In most patients, the deformity already occurs immediately after birth and “grows – deepens” with the growth of the child.

This pathology of the chest wall skeleton is more common in boys (men) than in girls (women): 3: 1 [1].

Funnel chest deformity, depending on the depth of the depression, can impair cardiac and respiratory function, as well as cause pain in the chest and spine. Often this pathology is combined with other diseases, incl.including the spinal column, Marfan syndrome, etc.

In addition, patients without any symptoms or complaints may experience strong negative psycho-emotional stress, as well as associated shyness and other social influences.

The Nuss procedure is a minimally invasive, low-traumatic video-assisted operation aimed at placing a metal plate (or plates) of a strictly defined size under the sternocostal complex, individually bent for a given type of deformity in a patient.
Plates are manufactured by a certified Russian manufacturer Pectus bar, manufactured by Biomet, USA.
Plates are made of ASTM F138 stainless steel in accordance with GOST R ISO 5832-1-2010.

The thoracic surgeon makes small incisions (up to a maximum of 2.5-3 cm, depending on the type of deformity) on the chest wall on the right and left and then, under the control of optics, conducts a special metal conductor (usually from right to left), thereby creating in the anterior mediastinum (between heart and inner surface of the sternum) a small canal.Further, a braid (thick rubber tube) is drawn into the formed channel in the opposite direction, to which an individually bent plate of a strictly defined (suitable for a given patient) length is tied. Under the control of the video camera, the plate is passed from left to right, then, under the control of the optics, the plate is rotated, which corrects the “retraction” of the sternum and ribs.

Both drainages are connected to Bobrov’s banks and a slight degree of vacuum-vacuum is created in the banks (about 0.2-0.25 atm) to evacuate air, fluid from the pleural cavity and control hemo-aerostasis.
Intraoperatively, we carry out X-ray control immediately after the completion of the operation using the C-X-ray arm located in the operating room, which completely eliminates any displacement of the installed plate and guarantees its optimal position.

The patient is transferred to the intensive ward for some time, then – after stabilization of the state – to the general ward.
Usually, the day after the operation, X-ray control is performed in the clinic.
After a decrease in the discharge according to the established pleural drains of less than 100-150 ml (depending on age) and the absence of air discharge, an alternate removal of the pleural drains is performed, followed by X-ray control (usually 2-3 days after the operation).

The next day after removal of the pleural drainage (3-4 days), the patient is discharged from the clinic, followed by mandatory monitoring of the condition of the postoperative sutures at the surgeon at the place of residence or at the clinic’s surgeon.

Intermediate postoperative consultations with a chest x-ray at 1,3, 6, 12 and 24 months after surgery are mandatory.

Funnel chest – diagnosis and surgeon’s indications

Etiology and pathogenesis of the concave chest. Why does a funnel chest deformity occur?

The most common deformity of the chest is a funnel-shaped deformity (CCD, Pectus Excavatum, “shoemaker’s chest”, cup-shaped chest, shoemaker’s chest).It refers to the so-called congenital malformations of the chest, which are found in 1 newborn in 1000 (according to some other statistics, in 3 people in 1000). 91% of all malformations of the chest are funnel-shaped deformities of varying severity.

VGDK exists in three forms:

• symmetric VGDK
• asymmetric VGDK,
• flat VGDK.

More detailed classifications have been proposed by different authors and are of great importance when choosing a treatment method and predicting the outcome of an operation.The most common classifications of the degree of deformity of the funnel-shaped breast were presented by Dr. Park (Hyung Joo Park, South Korea) and Dr. Zeng (Zeng Q, China).

Hereditarily acquired pathology progresses due to the accelerated, outstripping growth of costal cartilage. And this, in turn, leads to abnormal development of the chest – its retraction in 80% of cases of the development of the disease. Sometimes at birth, the defect (dimple) is practically invisible, but begins to progress rapidly during the period of active growth of the patient.In this regard, timely diagnosis of IOP and observation by a pediatrician, orthopedist, and thoracic surgeon is extremely important.

Diagnostics and treatment and diagnostic tactics of the concave breast. Funnel chest treatment

Diagnostics of pectus pectus is carried out on the basis of visual examination, X-ray examination, as well as computed tomography of the chest with 3D-reconstruction of the ribs. The condition of cartilage, ribs, connective tissue is assessed (to exclude the presence of Marfan syndrome and other disorders in the patient).In addition, diagnostics helps to determine the degree of deformity, the center of depression, the degree of displacement of the heart. All these data help to more accurately outline the tactics of treatment.

Contrary to popular belief, pectus deformity cannot be completely corrected by any other method than surgery. Swimming, wearing special orthoses, physical therapy, massage, lung development and other exercises certainly improve the situation, but unfortunately, they do not give tangible results.Surgical correction is today a safe and effective method of correcting pectus pectus excavatum.

Operations to correct IOP have been carried out since 1911, in Russia since 1949 (in adult patients) and since 1961 (in children).

To date, the Nass method has proven itself very well – the Nass operation, which is a minimally invasive method for correcting chest deformities.It has been used for more than 10 years and at the moment there is no actual alternative to the method in terms of its effectiveness and safety.

The method consists in introducing a metal plate (sometimes two) to the patient to help straighten the chest. After 3-4 years, the plate is removed, while the incisions are made in the same places as when the plate was installed. After removing the plate (s), the patient is considered absolutely healthy, and the chest is corrected. But this does not mean that for 3-4 years the patient lives in a sparing mode – already 6 months after the operation, you can return to your usual way of life and even play sports.

Complications caused by surgical correction using the Nass method are minimal, and the patient’s recovery period after surgery is also significantly reduced.

The satisfaction of patients with the results of the operation is also high (up to 98%), only 2% have residual deformity, this is due to deviations from the technology of the retrosternal canal during the operation. As the main advantages of the method, it should also be noted that it is less traumatic, has a short realizational period in comparison with other outdated operations for correcting EDHC and the absence of noticeable postoperative scars, i.e.because the production of small cuts on the sides allows you to completely correct the deformation.

In addition, the Nass method allows for repeated operations if the first operation did not achieve the desired effect, as well as in the case of correcting relapses, or correcting defects caused by other methods of chest corrections carried out at an early age.

Indications for surgical correction of the funnel chest

Surgical correction is recommended for functional, cosmetic and orthopedic indications.

To functional indications include violations that impede the normal functioning of the body. IOP leads to a decrease in the volume of the chest, which in turn affects the main functions of the internal organs.

From the point of view of the effect of the funnel-shaped deformation of the chest on the heart, its “irritation”, possible compression and even displacement relative to the normal position can be noted. The palpitations become more frequent and felt strongly, especially with exertion.There is shortness of breath, pain in the heart.

The deformation also affects the patient’s lungs – their vital capacity decreases, the mechanics of breathing are disturbed. After surgical correction, the oxygen transport system in the patient’s body is fully restored. Also, functional indications for the correction of a sunken chest include a general decrease in endurance and frequent colds.

The severity of the deformity is determined in several ways. For example, you can fill the area of ​​deformation with any liquid, thereby measuring the volume. This method is descriptive but not standardized. In order to determine whether a patient needs an operation or not, the Haller index (IG) is used. To do this, the patient undergoes computed tomography of the chest (RCT, MSCT) and calculate the ratio of the length of the chest along the midline (a) and the distance from the midline to the deepest place of deformity (b). If a / b is more than 3.25, the patient needs surgery.

To cosmetic indications include, first of all, the patient’s (or his parents’) dissatisfaction with the aesthetic state of the chest. Often, funnel chest deformity is accompanied by psychological disturbances, the presence of deep complexes and internal insecurity. This is especially true for adolescents who react painfully to the opinions of others. However, before the operation is performed only for cosmetic reasons, a more thorough examination of the patient is necessary in order to identify and compare all possible risks and results.

Orthopedic indications of for surgery are the most controversial indication. They are associated with the influence of the concave chest on the spine. Studies have shown the presence of certain disorders in the spine in patients with IOP, however, they are associated more with muscle tension than with changes in the spine. Nevertheless, successfully performed surgical corrections have a beneficial effect on the patient’s posture.

As for the age of the operation – the period before puberty (from 12 to 15 years) is considered optimal, as soon as the deformity began to actively manifest itself.The choice of this particular age is associated with the relative softness and elasticity of the chest during this period – therefore, the operation itself and the postoperative period are much easier. In addition, with timely correction, severe psychological consequences and the development of a feeling of self-inferiority in patients with EDHC can be avoided. If, for some reason, it was not possible to carry out the operation on time, today’s technologies allow the operation to be performed at any age.

If we talk about operations in early childhood, they are possible only for serious medical reasons, when there is a real threat to the patient’s life, or when deformity can lead to serious disorders in the development of the patient’s heart and lungs.

The haste to carry out the operation can cause various complications, as well as the recurrence of sunken breasts. If the operation is performed in early childhood, the risk of recurrence remains quite high. In addition, at an early age of a child, deformity is rarely so pronounced as to form complexes and psychological disorders in the child. Therefore, there is no need to rush with the operative correction of IOP.

Frequently Asked Questions (FAQ):

What is the reason for the appearance of a fossa on the chest in a child?

Funnel chest deformity is a congenital genetic pathology of the development of the sternum, ribs and cartilage. In children, this is usually a small fossa that progresses with the growth of the child. We recommend not to rush to the surgical treatment of children, to be monitored by a pediatrician, orthopedist, surgeon.

How effective is Vacuum Bell in correcting VDHK?

Its effectiveness is difficult to assess, since the use of Vacuum Bell is not indicated for all patients with IOP. For example, it is extremely difficult for women to use it. Vacuum Bell can slightly improve the appearance of the chest and reduce the funnel by about 30%.

How effective is wearing orthoses in conjunction with physical exercise for EDHC?

Orthoses are an effective way to correct IOP in children under 14 years of age. However, you need to practice regularly and continuously for at least 2 years. This program should be designed individually, for each patient. Unfortunately, such programs are still being developed in Russia. But foreign experience shows that the correct use of orthoses helps to improve the appearance of the funnel by 50-70%.

How should you behave before the upcoming surgery?

The recommendations are standard: alcohol and smoking are not allowed, medications are taken only in consultation with a doctor. Among other things, you will need to pass standard preoperative tests, undergo a CT scan of the chest or x-rays.

What anesthesia is used for Nass surgery?

Intravenous anesthesia is usually used in which the patient sleeps.At the end of the operation, when a few minutes remain until the last suture, the anesthesia is stopped so that the patient wakes up more easily and begins to breathe on his own. True, later most patients do not remember this moment.

How long does Nass’s chest deformity surgery take?

Operation Nass lasts from 30 to 60 minutes, depending on the degree of deformation and, accordingly, the number of plates installed – 1-2, 3. That is, the operation in which the correction is carried out using 1 plate takes on average 30 minutes.

How long after the operation can I go to work / study?

Depending on the type of work. If the work is office, at the computer, then in 1-1.5 months. If the work is accompanied by physical activity, lifting weights, then not earlier than after 6 months, or after 3 months, but with strictly dosed physical activity agreed with your doctor.

How long after my Nass surgery can I go in for sports?

3 months after the operation, dosage loads agreed with the doctor are allowed, and after 6 months you can go in for sports at full strength.

How long does it take to stay in the clinic after Nass surgery?

Postoperative hospital stay is usually up to 10 days.

What material is the pectus breast plate made of?

The plates are made of titanium. This metal is unique in that it has shape memory and does not oxidize.

Does the metal detector respond to the installed plate?

No, metal detectors do not react to titanium as it is paramagnetic (weakly magnetic). If you are still worried, you can take a certificate from the clinic that you have plates installed. Nowadays, many operations are performed with the installation of titanium elements in various parts of the body, so the security services will not be surprised.

How many plates should be placed when correcting a concave chest?

Depending on the degree of deformation, from 1 to 3 plates are installed. The final decision on how many plates to put is made during the operation, when access to the ribs has already been formed.With one plate, the postoperative period is a little easier than with two or three. Three plates are rarely installed.

How long does it take to remove the plate?

Plates are usually removed after 3-4 years. There are no strict criteria, but over time, the plate becomes overgrown with bone tissue and after a few years it is more difficult to remove it. Despite the youth of the method itself, there are already patients who do not remove the plate after 8 years, arguing that there is no time for surgery and recovery. This is not entirely correct. After the correction is over, the stitches have resolved, the internal organs have adapted, you need to remove the plate. The chest will remain fixed in its normal position. During the operation to remove the plate, the plate is opened on both sides, slightly unbent along the curvature and removed. The procedure takes place under general anesthesia; there is no need for epidural anesthesia.

How safe is plate rotation during Nass surgery?

It is absolutely safe.The opinions of some experts that the heart and lungs can be damaged when the plate is turned indicate that these doctors have a very distant idea of ​​how the Nass operation is performed and do not themselves perform it.

Is the Nass operation included in the VHI policy?

Since September 2016 Nassu’s operations are carried out at the Moscow State University Moscow State Scientific Center, where all Russian citizens of any age can count on federal quotas and quotas for the VMF.

I am a Muscovite, how can I get advice about a funnel chest?

It is best for Muscovites to sign up for a consultation and drive up for a full-time examination at the Medex Medical Center (m.Belarusian). The consultation is paid, it is better to check the cost by calling the clinic.

How can I get advice about VDHK if I live far from Moscow?

For nonresident patients, we provide both a consultation on photos and X-ray images (they can be sent to our e-mail: [email protected]), as well as consultations via Skype (Skype) using a webcam, microphone. With a video consultation, you should have 2 rulers at hand, one about 10 cm, the other about 30 cm.Place the light on the side, in front, but not behind. You can agree on the consultation time by e-mail or by phone +7 (499) 250-27-84. Skype name – drpectus

I have already had an open operation to correct the EDHC, I am not satisfied with the result, can I undergo a second correction?

Correction of an unsuccessful open operation is possible, however, it does not always give the desired result. The decision on such issues is made individually after examining the patient.

Do they take into the army with a funnel-shaped sternum?

VGDK is not a contraindication for military service. The only exception is the period after the correction of the funnel chest, while the plate is in the patient’s body. Calling is also possible after removing the plate.

Back to section

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

Although most chest fractures are conservatively treated, sometimes surgical fixation becomes necessary.The sternum anatomy and stability of the anterior chest wall are restored with firm fixation using a locked osteosynthesis plate. The use of very thin plates (1.5 mm or 2.0 mm thick) ensures adequate stability on the one hand and high patient comfort on the other ^12. for example, LCP systems or plates designed for other bones such as the cervical spine or distal radius ^{6. 27.}

The closed plate is considered to provide an advantage in biological fixation to be functional as an internal fixator with significantly reduced friction between plate and bone ^9. Positioning such an internal fixator on the anterior surface of the sternum provides sufficient fixation of the convex FRacture surface and thus thus reducing the pulling forces to destruction. At the same time, each respiratory movement causes compression of the inner sternum cortex and destruction, thus stimulating bone healing.Each screw must be locked securely in order to ensure the effectiveness of the internal retainer.

As we recommend fixing each fragment with at least three screws, there can be no limitation in the case of very short fragments. Possible solutions for the lintel of these fragments, and the use of special plates that allow longitudinal and transverse fastening in one person. In the future, “T” or “H” -shaped plates may be useful in those situations.

Some surgeons show a reluctance to work on the chest wall, probably due to a lack of experience in this particular area.There is a need for a simple and reliable method to stabilize the sternum ^1.12. The method described above represents one of the possible STAndards and reduces the risk of complications from surgery through accurate preoperative planning, subperiosteal soft tissue dissection, and limited drilling depth. There lies the difference in the use of any other plates does not provide the possibility of limited drilling depth (table 1), while preoperative planning, preparation stages and fracture reduction can be performed similarly to the described method of this manuscript,

As a three-dimensional reconstructed CT scan allows to diagnose fractures of the sternum and associated fractures with high sensitivity, the surgeon receives detailed information about the injury ^28.29.The CT shows a particular position and direction of rupture, as well as any dislocation. This critical information simplifies preoperative planning for a targeted surgical approach, as shown in steps 1.1-1.5. In addition, it allows precise planning of the number and design of the plates to be used for fixation, as shown in steps 2.2-2.3. Perhaps the limitation of CT is the difficulty in showing undislocated fractures and cartilage abnormalities, although these could contribute to chest wall instability.

Subperiosteal dissection and depth-limited drilling are the two most important steps to surgical safety.

Reduction of sternum fragments from their anatomical position usually requires an approach to the posterior wall of the sternum. This procedure can injure the mediastinal organs, the surrounding vessels and the sternum ^7.18 blood supply. Performing a strictly subperiosteal incision near the sternum, as shown in step 2.1.7, will minimize the risk of complications.Fractures, which show lateral dislocation, may have fragments of their own moving very close to the internal thoracic vessels. In those cases, the surgeon should be aware of any damage to those vessels that could lead to serious bleeding. At the time bleeding in a given region is identified, the surgeon should immediately stop it through the intercostal approach to the inner thoracic vessel. Dissection of the intercostal muscles and insertion of a distributor into the affected intercostal space provides quick and proper access to the injured vessel.

Drilling too deep should be avoided as this can cause life-threatening injuries to the mediastinum. This is ensured by the depth of limited drilling in combination with the measurement of the thickness of the sternum and the selection of a drill bit of the appropriate length ^12.

Summarizing the considered limitations of the procedures and the possible implementation of the anterior sternum covering with low profile blocked titanium plates can be expected to be successful if preoperative planning with the help of computer tomography, subperiostal opening and depth-limited drilling is performed.

Postoperative Fusion – HUG Neurosurgery Geneva | HUG

Day of Surgery

Before you are transferred to your room, you will receive thorough care in the anesthesia room. A team of service personnel will answer your questions, coordinate and provide assistance related to your health condition.

After the operation, you can start drinking as soon as the sounds of intestinal peristalsis appear (“rumbling” in the abdomen or flatulence).The nurse, with your help, will regularly assess your pain and adjust your medication based on the severity of the pain. However, do not hesitate to tell the nursing staff about any pain or discomfort you are experiencing.

For 48 hours, every four hours, day and night, the nurse will check your limb sensitivity and mobility.

After the operation, you will remain on your back for the time prescribed by the surgeon, and then a member of the service team will help you roll onto your side using the positions below.

Relaxed position with a pillow
under the knees

On the side with a pillow
between the legs

The first days after surgery

You can usually start eating the next morning, depending on the permission of the neurosurgeon from the speed of the resumption of intestinal transit. At the discretion of the neurosurgeon, you can be placed on a bed with a raised (30 °) headboard without using a pull-up rack.You will be given an x-ray (x-ray or CT scan) either during surgery or within 48 hours after surgery, but always before the first ascent.

The first time you get up, a nurse or physical therapist will help you sit on the edge of the bed and then into the wheelchair. You will then be taken to the washroom to clean yourself up.

Depending on your surgery, your doctor may prescribe a brace or neck collar to help support your spine during movement.

“The most difficult thing in the early days was movement: getting up, moving in bed, sitting down was painful. Physical therapists quickly taught me how to climb according to a strict protocol. They gave me an illustrated brochure that beautifully depicted the correct postures showing how to avoid movement in the operated areas. The pain became less and less every day. I was looked after all the time, even at night ”
Mark, 55

How to get out of bed correctly?

These exercises help protect your back while lifting.Strictly follow these guidelines throughout your recovery period.

For cervical spine surgery

Roll over on your side with your whole body

Raise the back of the bed as much as possible

Lower your legs and push up

with your hands

back straight

For lumbar spine surgery

Roll over on your side with your whole body

Keep your back straight, lower your legs and push off with your arms to sit down

From 3 to 6 days after surgery

You can shower, being careful not to get the dressing (s) wet. The service staff will help you wash your back.

The physiotherapist will walk with you down the hallway. You will do the exercises with him, and he will advise you on the movements and / or postures that you will need to adhere to.

Toning exercises for the trunk after lumbar spine surgery.

The movements described below will strengthen the dorsal and abdominal muscles.

While exhaling, press down on the bed with your head, with both hands, left foot and extended right leg, while inhaling, relax.Perform this exercise again, pressing with your now right foot and extended left leg. If you can, repeat the exercise 10 times on each side.

While exhaling, press your left hand on your right knee, while inhaling, relax. Do this exercise again with the other leg. If you can, repeat the exercise 10 times on each side.

As soon as possible, the physiotherapist will guide you to the stairs and go up and down the stairs with you.