Costochondritis (for Parents) – Advocate Aurora Health

What Is Costochondritis?

Costochondritis (kos-tuh-kon-DRY-tis) is a painful swelling of the cartilage that attaches the ribs to the breastbone (sternum). It’s one of the most common causes of chest pain in kids and teens, and happens more often in girls than boys.

Costochondritis — also called chest wall pain or costosternal syndrome — can cause a sharp, stabbing pain. Usually, it’s harmless and goes away on its own after 2 or 3 days.

What Causes Costochondritis?

Doctors often can’t pinpoint the exact cause of costochondritis. But sometimes it’s linked to:

• an injury to the ribs or breastbone
• physical strain due to heavy lifting or strenuous exercise
• repeated coughing (as can happen with some infections)

What Are the Signs & Symptoms of Costochondritis?

The main symptoms of costochondritis are pain and soreness in the chest. A sharp pain is usually felt on the left side of the breastbone, but can be on both sides.

The pain can get worse when a child:

• takes deep breaths
• coughs
• moves the upper body
• presses on the affected area

Pain may ease a little when the child stops moving or takes shallower breaths.

A heart attack is rarely the cause of chest pain in young people. Still, it helps to know how costochondritis pain differs from heart attack pain:

• Heart attack pain is usually more widespread and felt in other body parts, like the arms and neck. It also feels as if it’s coming from under the breastbone.
• Costochondritis pain usually is felt only in a small area of the chest and feels as if it’s coming directly from where the breastbone meets the ribs.

How Is Costochondritis Diagnosed?

To diagnose costochondritis, the doctor will:

• ask about the symptoms
• feel for tenderness along the area where the breastbone meets the ribs

The breastbone and ribs are connected by rubbery

cartilage at points called costosternal joints. It’s in one or more of these joints that the pain is felt.

Costochondritis can’t be seen on a chest X-ray, but the doctor may order one to rule out other possible causes of chest pain, such as pneumonia.

How Is Costochondritis Treated?

Costochondritis usually goes away on its own without any treatment within a few days. Sometimes, it lasts longer — from several weeks to months. If you’re concerned about pain that’s not going away, talk to your doctor.

In the meantime, the doctor will probably recommend giving your child over-the-counter pain medicines like ibuprofen or naproxen to help ease symptoms. Applying a warm compress or a heating pad (set on low) to the sore area also may give some relief.

Until feeling better, your child should get plenty of rest and avoid activities that make the pain worse.

Can Costochondritis Be Prevented?

It’s not always clear what causes costochondritis, so you can’t completely prevent it. But many cases are caused by heavy lifting, like carrying an overstuffed backpack — especially on one shoulder, which many kids do. So if your child has to carry lots of books, buy a supportive backpack that spreads weight evenly over both shoulders and make sure it’s worn over both shoulders.

When Should I Call the Doctor?

If your child has chest pain that doesn’t go away, call your doctor or go to a hospital emergency room. Chest pain rarely is serious in kids. But sometimes it can be the sign of an emergency that needs medical care right away.

Kids Health Information : Pectus carinatum (pigeon chest)

Pectus carinatum (PC, or pigeon chest) is a chest wall deformity where there is overgrowth of the cartilage between the ribs and the sternum (breastbone), causing the middle of the chest to stick out.

PC is most common in adolescent males, and 90 per cent of cases are diagnosed after children are 11 years old. The condition becomes more noticeable during puberty when the body goes through a growth spurt. PC continues until the bones stop growing, usually around 18 years of age.

PC does not usually affect the internal organs or cause any problems in the way the body functions, although some patients will become short of breath more easily during exercise. PC can impact on your child’s social life or self-esteem, especially when they are at the beach, pool or
changing room. 

PC is usually treated with a brace called a chest orthosis; however, occasionally surgery is required.

Signs and symptoms of PC

If your child has PC, they may have a distorted chest wall with their breastbone sticking out of their chest. Sometimes only one side is affected, making the chest asymmetrical (uneven). In most cases there are no other symptoms, but some children also experience:

• shortness of breath during exercise
• tenderness or pain in the area of overgrowth
• more frequent respiratory infections (e.g. colds)
• becoming tired easily.

When to see a doctor

If you think your child has PC, see your GP. They will examine your child and refer you to a paediatric surgeon. Diagnosis is confirmed by doing an X-ray and sometimes an assessment of your child’s lung function and tolerance to exercise. PC is sometimes associated with other
conditions, and your child will need to be assessed for these. 

Treatment with a chest orthosis

Although some cases will require surgery, most children with PC will need a chest orthosis, also known as a brace, to help correct the shape of their chest wall. The brace compresses (squeezes) the overgrown ribs or breastbone back to a ‘normal’ position. An orthotist will fit your child’s
brace, which is worn until the chest has flattened and the chest wall can stay in position by itself – this can take many months.

There are two main stages of wearing the orthosis: corrective and maintenance.

• Corrective phase – in the first three to six months the orthosis is worn 23 hours a day.
• Maintenance phase – when the chest overgrowth has flattened enough, the orthosis is worn for eight to 10 hours each night. The maintenance phase usually lasts another three to six months. If the protrusion reappears during the maintenance phase, your child will need to restart the
  corrective phase and wear the brace for 23 hours a day.

Your orthotist will show your child how to wear the orthosis correctly and adjust it appropriately. The orthosis should not be worn during high-intensity activities, such as sport.

Care at home

• When the orthosis is removed each day, check the skin to make sure there is no rubbing or skin breakdown on the protruding chest. Mild redness over the protruding chest is normal and to be expected, but there shouldn’t be sores or rashes. Wearing a singlet or T-shirt under the brace will
  stop the skin from rubbing and becoming damaged or sore.
• Your child’s chest will become sweaty under the orthosis. They will need to wash the skin every day beneath the front and back pads (remove the brace while your child is washing, and dry the skin thoroughly).
• Feeling slight pressure while wearing the orthosis is normal. However, if your child feels any pain while wearing the orthosis, contact the orthotist for a review.

Contact your orthotist if you have any questions or concerns regarding your child’s treatment with a chest orthosis.

Follow-up

Treatment is monitored by frequent orthotic reviews and with the use of 3D photography. The chest orthosis is reviewed one week after fitting and then every four weeks after that. Your orthotist will arrange reviews to monitor the progress of your child’s chest and will adjust the
orthosis as required. 

Following the removal of the orthosis, your child will have an orthotic review and 3D photographs taken every six months, until their chest is stable.

Key points to remember

• Pectus carinatum (PC) is a chest wall deformity that usually does not affect the internal organs.
• A chest orthosis (brace) is used to treat PC. In the corrective phase, the orthosis is worn 23 hours a day, and in the maintenance phase, for eight to 10 hours a day.
• Treatment is monitored by frequent orthotic reviews.

For more information

• See your GP, paediatrician, surgeon or orthotist.

Common questions our doctors are asked

My son has asthma. Will the orthosis cause any problems?

Usually this is not a problem, but if your child has an
asthma episode and is having difficulty breathing, you should remove the
orthoses until he has fully recovered. An orthosis should not be worn during
strenuous exercise/sport.

In the corrective phase, is it OK to remove the orthosis for
longer than an hour if it’s a special occasion? 

It is OK to remove the orthoses for brief periods, like
during a special occasion, but in general, the longer it is worn, the quicker
and better the outcome will be.

After treatment will my child’s chest look completely
normal?

Chest orthoses often
achieve excellent results, but in extreme circumstances, surgery may be
required to correct the deformity. Despite scarring, your child’s chest will
usually achieve a normal shape following this procedure.

Developed by The Royal Children’s Hospital Orthotic and Prosthetic department. We acknowledge the input of RCH consumers and carers.

Reviewed May 2021.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.

Sore ribs in pregnancy – HSE.ie

Rib pain is very common in pregnancy, especially during the third trimester (weeks 28 to 40).

Make an appointment to see your GP if you are less than 12 weeks pregnant and you get shoulder or rib pain. In rare cases this can be a sign of an ectopic pregnancy.

Causes of rib pain in pregnancy

During pregnancy some changes happen to your body that can make rib pain more likely.

Breasts getting bigger

This extra weight can cause rib pain.

Hormonal changes

The hormones of pregnancy cause your ligaments to relax and soften. This may mean that the bones in your chest wall move more than they normally would and could cause pain.

Baby getting bigger

As your baby grows and takes up extra space inside you, they may put pressure on your chest wall and ribs.

Heartburn, acid reflux and indigestion

Heartburn, acid reflux and indigestion can give you rib pain during pregnancy. This is because your baby is putting pressure on your stomach.

Urinary tract infection

Rib pain, particularly in your lower ribs at the front or the back, can be a sign of a urinary tract infection.

Preventing rib pain in pregnancy

1. Be mindful of your posture – sitting up straight with your head up and shoulders back reduces your risk of rib pain. It also reduces pain in your upper back and neck.
2. Wear a properly-fitted and supportive bra and avoid underwire. It might be worth getting a nursing bra that you can wear after the baby is born.
3. Pregnancy yoga and pilates helps improve posture and strength and flexibility of muscles.
4. Deep breathing exercises during the day may help, as well as before bedtime.
5. Try using a few pillows at bedtime to help you get comfortable.

Ways to deal with the pain

Stretches

There are some stretches that can help you when you have pain in your ribs.

Follow these steps:

1. Try sitting and bending your upper body sideways.
2. Bend away from the side of the pain.
3. Raise the arm on the same side as the pain above your head.
4. Hold for a few minutes, taking deep breaths in and out.
5. Relax. Then return to normal.

You can ask for a referral to a chartered physiotherapist who can tailor exercises to your needs

Other things that may help

• Heat treatment – half fill a hot water bottle and hold it to the area where the pain is (the ribs area, not on the bump).
• Ask your GP, obstetrician or midwife to refer you to a chartered physiotherapist.
• Painkillers – you can get a prescription from your obstetrician or GP.

When to get urgent medical help

If your pain doesn’t improve

Ask your GP or obstetrician to refer you to a chartered physiotherapist who specialises in women’s health.

Chest pain? It might be one of these 7 things

Some of them — like that chest muscle you pulled raking leaves last fall — are more annoying than serious. But others can be far more serious.

Health.com spoke to three leading cardiologists across the country, and all of them reiterated one thing: If you’re having chest pain, and you’re not 100% sure what’s causing it, either call your doctor or call 911.

“I know of one person who died and the last thing in their search bar was ‘heart attack symptoms,'” says Sharonne Hayes, a cardiologist at the Mayo Clinic in Rochester, Minn.

Christine Jellis, MD, PhD, a cardiologist at Cleveland Clinic, seconds that. “As a physician, I would much rather let someone know that it’s nothing to worry about than have someone [come to us] too late and has permanent damage,” Dr. Jellis says.

Here are seven conditions that can cause chest pain — and what everyone should know about to treat them.

Heartburn

You might be wondering how someone could mistake the symptoms of acid reflux for a heart attack, but there’s a reason why it’s called heartburn, after all.

Gastroesophageal reflux occurs when a person’s stomach contents — including the gastric acids that help break down food — back up into the esophagus, the tube that connects the throat and stomach.

Stomach acid is highly acidic, hence, the burning sensation behind your breastbone; on the pH scale, it scores about a 2 (PDF), falling somewhere between battery acid and vinegar. (Our stomachs are lined with protective membranes that shield it from the corrosive effects of acid, while our esophagus does not.)31 Superfood Secrets for a Long and Healthy LifeThe occasional reflux is fairly common and probably nothing to worry about, but if you’re experiencing it twice a week or more, you may have gastroesophageal reflux disease (GERD). Left untreated over time, GERD can cause asthma, chest congestion, and a condition called Barrett’s esophagus, which may increase your chances of developing a rare type of cancer.

Muscle strain

Weekend warriors, take note: If you haven’t lifted anything heavier than a MacBook for more than a few years, you might want to rethink that CrossFit class you signed up for.

It’s possible for someone to mistake a strained chest muscle for something more serious, like a heart attack, says Dr. Jellis. “I had a patient who came in with chest pain and he was worried he was having a heart attack,” she says. “After taking his history, I learned he had moved [to a new house] and hadn’t lifted heavy furniture in years. But he did the right thing, coming in.”

Doctors don’t expect patients to be able to tell the difference between a heart attack and a pulled chest muscle, she says, but a good rule of thumb is that if you can press on the wall of the chest and it feels even more painful, it’s more likely to be a musculoskeletal injury than a problem with your ticker.

Costochondritis

An estimated 13% to 36% of adults who show up to the emergency room or their doctor’s office with acute chest pain are diagnosed with costochondritis, or inflammation where a rib bone meets up with the cartilage, according to a 2009 review in the journal American Family Physician. Although doctors can’t always pinpoint what triggered the condition, the culprits can range from viral infections to chest injuries.

Typically, people feel a type of pressure on their chest wall and — similar to a strained muscle — a tenderness when they press on the area.

In this case, a doctor will probably start by taking your medical history and doing a physical exam. “A physician is going to want to rule out cardiac and other serious issues first,” says Dr. Jellis. “It’ll most likely be a diagnosis by exclusion.” If you do have costochondritis, the pain typically goes away in a few days or weeks; taking over-the-counter painkillers can help.

21-Day Power Up Your Veggies Challenge

Shingles

The virus that causes chickenpox lingers in your body long after the spots have faded. In fact, varicella-zoster can reactivate in adulthood (usually in people older than 50) as a disease called shingles.

The first symptoms include itching and burning skin. If the area over the chest is affected, someone might mistake this new pain for a heart attack or other cardiac issue, says Salman Arain, MD, an interventional cardiologist with McGovern Medical School at the University of Texas Health Science Center at Houston and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center.

A few days later, however, the telltale rash can appear, followed by blisters.

If you think you have shingles, you should call your doctor ASAP. Antiviral medications can lessen the pain and shorten the duration of the symptoms, but only if you take them within 72 hours of the rash appearing. If it’s too late to take antivirals, your doctor can prescribe a prescription painkiller.

Pericarditis

If you’ve been battling a viral infection for the last few days, then suddenly wake up to a sharp, stabbing pain in your chest, you may have developed pericarditis, an inflammation in the layers of tissue that surround our heart, says Dr. Arain.

Respiratory infections are often to blame, though other culprits include autoimmune disorders like lupus and rheumatoid arthritis. Although pericarditis is usually benign, says Dr. Arain, it can really impact your quality of life.

Your doctor may diagnose your condition after ordering a CT scan, EKG, or chest x-ray. Chances are, however, your pericarditis will clear up in a few days or weeks simply by resting or taking over-the-counter pain medicine like ibuprofen, which also helps quell inflammation.

Pancreatitis

Just because a person’s chest pain isn’t heart attack-related doesn’t mean that it isn’t dangerous. One example: acute pancreatitis — the sudden inflammation of the pancreas, which is located just behind the stomach. “Intense abdominal pain can radiate up to the chest,” says Dr. Arain. “And the pain from pancreatitis is usually a deep-seated, intense pain.”

Oftentimes, pancreatitis occurs when gallstones (usually made of hardened cholesterol) trigger inflammation in the pancreas — something that’s more likely to occur in women than men. If you think you have pancreatitis, you should get medical attention right away; you’ll probably have to stay in the hospital for a few days to get antibiotics, IV fluids, and pain medication. Your doctor will also want to do blood work and order other tests, like a CT scan or abdominal ultrasound.

Coronary artery disease

Coronary artery disease (CAD) is a type of heart disease caused by a buildup of plaque in the arteries that supply blood to the heart. Over time, cholesterol deposits lodge themselves in the walls of these arteries, which can blocks off blood flow and cause chest pain.

While CAD can cause a sudden heart attack, it can also contribute to heart failure and arrhythmias. If you do receive a coronary artery disease diagnosis, your doctor may want to start you on statins, insert a stent into one of the arteries, or schedule you for bypass surgery.

Which brings us back to the number one rule cardiologists gave us: If you’re experiencing chest pain, it’s important to get it checked out, stat.

“One of the biggest public health messages has been to get people to take action when they have chest pain,” says Dr. Hayes.

“And we still have people who ignore their pain, who feel chest pain but who don’t think heart attack… I understand being worried about, what if the ambulance shows up in my driveway and I come back and it was just indigestion? And that’s why I specifically say, ‘There have been enough people who have died at home thinking it was indigestion and it was really a heart attack.’ If it’s a new symptom and you’ve never had it before, or the pain is coming or going or getting worse, call 911 — don’t call your girlfriend or your husband or drive yourself. Just call.”

Xiphoid syndrome: an uncommon occupational disorder | Occupational Medicine

Abstract

We report a case of a 45-year-old man, complaining of swelling and pain in his epigastric region for the last 3 years. According to his medical history, he had undergone various investigations and treatments for gastro-oesophageal reflux, without relief. He had had a history of chronic repeated microtraumas to his sternum during 9 years of working as a carpenter, as a result of placing wood against his anterior chest wall and pushing the former into a plank cutting machine. On examination, a tender swelling was palpable as an immobile, hard mass showing minimal protrusion under the skin on the xiphoid process. He was diagnosed as having xiphoid syndrome. We prescribed anti-inflammatory medication and advised him to avoid pressure on his anterior chest wall, especially on the sternum, while cutting wood. At follow-up, the symptoms were relieved. Xiphoid syndrome may be seen in people performing hard physical work who incur sustained pressure or friction on their anterior chest wall. The case emphasizes the importance of the occupational history as well as clinical and radiological investigation of unusual conditions as mentioned above.

Introduction

Xiphoid syndrome involves painful swelling and discomfort of the xiphoid process of the sternum [1]. Inflammation of the xiphoid process, causing xiphodynia, arises from mechanical injury to that anatomic region. The prevalence of xiphoid syndrome is not well known as there is limited literature on this rare condition. In this article, we describe a case of xiphoid syndrome, occurring as a result of an occupational injury, drawing attention to this painful condition that can be mistaken for other causes of chest and upper abdominal pain.

Case report

A 45-year-old male was referred to our clinic with swelling and pain in the xiphoid region. He complained of chest pain and discomfort when lying in the prone position or when light pressure was applied to his chest (for example, during hugging someone or taking a deep breath). Over the preceding 3 years, he had previously undergone extensive physical examination and laboratory and radiological investigations such as computerized tomography (CT) of the thorax and none of them had revealed any significant abnormality. He had used anti-inflammatory medication intermittently and yet had no complete relief. He had also undergone gastric endoscopy the previous year because of a provisional diagnosis of an ulcer as a result of pain and swelling in the epigastric region. Finally, his symptoms were attributed to gastro-oesophageal reflux and he used anti-reflux treatment for 14 months without pain relief.

On physical examination, an immobile, mass-like protrusion was palpated in the xiphoid region. The patient had a history of chronic repeated microtraumas to his sternum, as he had worked as a carpenter for 9 years. He mentioned that in his work, he placed pieces of wood against his anterior chest wall and pushed them forward into a plank cutting machine. We concluded that in using his anterior chest wall repeatedly in this way he had caused chronic damage to the xiphoid process.

He underwent routine laboratory tests with unremarkable results. Chest radiographs in two projections (posteroanterior and lateral) showed ventral deviation of the xiphoid process on the lateral view, explaining the mass-like protrusion palpated on the chest wall (Figure 1). To exclude any bony lesion causing such symptoms, a CT scan of the thorax (Siemens Somatom Spirit, multi-slice CT, Erlangen, Germany) was performed and reformatted images in coronal, sagittal and axial planes were obtained. On the sagittal images, the patient had a ventrally deviated xiphoid process confirming the lateral chest X-ray findings (Figure 2). No other chest wall or upper abdominal mass was identified.

Figure 1.

Lateral X-ray shows hook-like anterior protrusion of the xiphoid process, which can be mistaken as a mass in the epigastric region on physical examination.

Figure 1.

Lateral X-ray shows hook-like anterior protrusion of the xiphoid process, which can be mistaken as a mass in the epigastric region on physical examination.

Figure 2.

Thorax CT scan in the sagittal plane in reformatted image shows the hook-like anterior protrusion of the xiphoid process more clearly. This is considered an anatomic variation. The xiphoid process was measured 4cm in the longitudinal dimension. No other pathologic condition was noted on the CT images.

Figure 2.

Thorax CT scan in the sagittal plane in reformatted image shows the hook-like anterior protrusion of the xiphoid process more clearly. This is considered an anatomic variation. The xiphoid process was measured 4cm in the longitudinal dimension. No other pathologic condition was noted on the CT images.

The patient was diagnosed as having the xiphoid syndrome according to the clinical and radiological findings. Non-steroidal anti-inflammatory drugs were prescribed for 2 weeks and he was advised to avoid pressure on his xiphoid process while at work. The pain was relieved and his symptoms were reduced at follow-up after 3 weeks. At 3 months of follow-up, he mentioned that he used anti-inflammatory drugs only when he felt pain in his xiphoid region and that he had stopped using his anterior chest wall at work.

Discussion

Trauma is an important factor in the aetiology of the xiphoid syndrome. Acceleration and deceleration injuries [1], blunt trauma to the chest [1], unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia [2], probably because of the muscular attachments to the xiphoid process. Cardiac or thoracic surgery also involves trauma to the chest wall, which may change the morphology of the sternum and cause xiphodynia. Enomoto et al. [3] observed that in a patient with a history of mitral valve replacement, the xiphoid process was elongated by 6cm and protruded anteriorly, 1 year after the operation. They suggested that the xiphoid process was separated from the sternum and pulled down inferiorly by the rectus abdominis muscle and then reconnected to the sternum, so that it was elongated [3], a mechanism, which they suggested was similar to distraction osteogenesis in limb-lengthening operations [3].

Our patient had no history of any cardiac or thoracic surgery, but a history of repeated microtrauma to the sternum incurred during his work while leaning against wood and exerting force with his anterior chest wall. Microtraumas can result in stress fractures and may cause new bone formation. New bone formation may also occur as a response to an insult such as tumour, infection, certain drugs, some arthritic conditions as well as trauma [4]. According to our observations, after the patient ceased using his chest wall while cutting wood, pain relief was established by the third week of the follow-up and anti-inflammatory drugs had helped to diminish the inflammation and resulting pain.

In conclusion, an occupational history as well as thorough clinical and radiological assessment can be import ant for correctly diagnosing and identifying the cause of rare conditions like the xiphoid syndrome. This disorder may be seen in people performing hard physical work who use their chest wall, such as the carpenter in our case. Clinicians should be aware of this disorder and the diagnosis should be made by exclusion after careful examination and appropriate clinical investigation.

• Well-known causes such as acceleration and deceleration injuries and blunt trauma, unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia, the latter two because of the muscular attachments to the xiphoid process.

• Repeated microtraumas to the bony parts of the body during heavy physical activity can result in stress fractures and resulting new bone formation.

• People performing hard physical work who use their chest wall to exert force may be predisposed to the xiphoid syndrome.

Conflicts of interest

None declared.

References

1.

.

Xiphodynia: a diagnostic conundrum

.

Chiropr Osteopat

2007

;

15

:

13

.2.

.

Xiphodynia: a report of three cases

.

J Emerg Med

1998

;

16

:

177

–

178

.3.

.

Postoperative elongation of the xiphoid process—report of a case

.

Ann Thorac Cardiovasc Surg

2011

;

17

:

307

–

309

.4.

.

Periosteal reaction

.

AJR Am J Roentgenol

2009

;

193

:

W259

–

W272

.

© The Author 2013. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]

X = The Xiphoid process. Everything you need to know.

Everything you need to know about the xiphoid process

Even though it sounds like some complex medical procedure, the xiphoid process is nothing more than a bone (or bony cartilage depending on how old you are) right at the base of your sternum.

Ordinarily, your xiphoid will give you no cause for worry over the cause of your lifetime. Since it is not a stress carrying bone, nor exactly movable, it pretty much just sits in the middle of your chest doing nothing, or next to nothing.

But in some situations, you may have issues with your unobtrusive xiphoid process. How do you know the pain you feel is from your xiphoid? What can you do about it?

We’ve provided answers to all these questions and more within this article.

What is the xiphoid process and what does it do?

Also called the metasternum, the xiphoid cartilage or if you want a tongue twister, the xiphisternum, the xiphoid process is a small extension of bone just below your ribcage.

The name of the bone itself, xiphoid, derives from a Greek that basically means “straight sword”. That sort of explains the shape of the xiphoid as it looks like a very short sword, widest at the base and tapering off to a point heading off towards your stomach.

The xiphoid doesn’t start out as a bone though. It starts out as a structure made of cartilage at birth and then slowly hardens into the bone as you mature. It takes a long time to harden though and will not entirely become bone until your early 40’s.

So if you’re less than 21, that bump you notice just below your sternum is unlikely to be your xiphoid. You’ll need to look elsewhere.

What does the xiphoid do? Well, nothing really active. For one, it serves as a landmark that indicates where chest compressions may be administered during cardiopulmonary resuscitation (CPR). Just a caution here though: If you’re doing CPR, don’t lean on the xiphoid. If you do, it may break off and puncture the lungs. That’ll be serious.

The xiphoid also serves as an attachment point for organs and large muscles that make up the floor of the diaphragm. It also plays a part in the abdominal muscles that compress and flex the abdomen.

So, it doesn’t really do anything active and if you were suddenly to lose your xiphoid, you probably won’t miss it very much.

Pain and inflammation in the xiphoid process

Even though the xiphoid is generally unobtrusive, it can be a source of pain, especially when it is inflamed. This pain is usually called xiphodynia, the xiphoid syndrome or even xiphoidalgia.

The pain, which may be mild or far from mild, is generally felt in the lower part of the sternum, just above your abs. Now, when there’s a pain in the xiphoid process, there are many reasons why it may be so. They include pain from:

•>

If the lump you feel around your xiphoid is painless, then there may be a more natural explanation. The xiphoid is generally inverted. This means that for the majority of people, the xiphoid faces inward so there’s no lump on their chests.

However, about 5% of people have what is called a “protruding” xiphoid process. For these people, the xiphoid protrudes out of the chest, forming a lump that may look like a tumour. It’s totally harmless though and a perfectly natural phenomenon.

What is the treatment for damage to the xiphoid process?

Well, before thinking about treatment, you need to visit your doctor first and confirm that what you do have is xiphodynia. Generally, if you have felt this pain for more than one week, then you should see a doctor for assessment.

There may be some difficulty with the diagnosis due to the fact that the xiphoid could be mistaken for a lump or a hernia. Also, because of its proximity to several bone structures, it could be mistaken for a broken rib, especially where the pain is severe.

Magnetic resonance imaging (MRI) or a computerized tomography (CT) scan will take care of the diagnosis nicely though. These tests can An x-ray can reveal damage to the xiphoid. If the x-ray results are inconclusive, your doctor may recommend further testing.

The treatment for xiphodynia depends on its cause. Generally, and especially in the case of an accident, a doctor may prescribe anti-inflammatory drugs to reduce the pain. If it is caused by weight lifting, the doctor may also recommend that you avoid intense exercise or activities that put a strain on your xiphoid.

Pain caused by acid reflux would ordinarily include recommendations to avoid foods that could trigger a reflux such as chocolates, peppermint and tomatoes.

Surgery may be considered as a last resort in the event of severe damage to the xiphoid such as its breaking. If left that way, it may be very dangerous as there’s a risk that it will puncture the lungs.

How do you hide the bump on your sternum?

As mentioned earlier, if what you have is a painless bump, you may have no cause to worry. The bump, in this case, is most probably caused by a protruding xiphoid process, an entirely natural phenomenon.

There’s no danger to you here. But some people are very self-conscious about what they fear may be perceived as a defect. So it’s normal for you to ask how you can hide the bump on your sternum.

You may have heard (or may think) that doing some more exercise around your pecs and abs will hide the bump or make it less noticeable. Nothing can be further from the truth.

When you exercise your pecs, only the muscles to either side of the sternum develop and get filled out. The area along your sternum will maintain its depression so what you have after exercising that area may be a more prominent bump.

The best thing to do is leave it alone. The bump is entirely natural and hardly anyone will notice it. Unless, of course, if you keep directing their attention to it by being overly self-conscious.

If you are intentional about getting rid of the bump, you can approach your doctor to explore the possibility of getting a surgery. You should think this over carefully though.

Conclusion

As you have seen from this article, there are many reasons why you could be experiencing the pain below your sternum. But you need to take it slow and consult your doctor before taking any other steps.

A Report of Two Cases

Vitamin D is integral for bone health, and severe deficiency can cause rickets in children and osteomalacia in adults. Although osteomalacia can cause severe generalized bone pain, there are only a few case reports of chest pain associated with vitamin D deficiency. We describe 2 patients with chest pain that were initially worked up for cardiac etiologies but were eventually diagnosed with costochondritis and vitamin D deficiency. Vitamin D deficiency is known to cause hypertrophic costochondral junctions in children (“rachitic rosaries”) and sternal pain with adults diagnosed with osteomalacia. We propose that vitamin D deficiency may be related to the chest pain associated with costochondritis. In patients diagnosed with costochondritis, physicians should consider testing and treating for vitamin D deficiency.

1. Introduction

Chest pain is a leading cause of ambulatory visits and accounts for over 6 million emergency room visits in the United States [1]. After serious cardiopulmonary conditions are considered, musculoskeletal causes of chest pain, including costochondritis, are commonly attributed to the final diagnosis [2, 3]. Costochondritis is not clearly understood, but may be related to inflammation of the costochondral junctions associated with illness, coughing, or trauma [3]. Although there are a few reports of osteomalacia and vitamin D deficiency associated with chest pain [4–6], we are not aware of any literature reports of costochondritis associated with vitamin D deficiency. This paper describes two cases of patients with chest pain, eventually diagnosed with costochondritis and vitamin D deficiency.

2. Cases

Case 1. A 35-year-old white female presented to the family medicine clinic in Hawaii with complaints of chronic chest pain for the last 3 years. She recently moved from Northern Virginia to Hawaii. Chart review was notable for a negative cardiac workup, including a treadmill stress test, and echocardiogram. Over the last 3 years, the diagnoses of her chest pain included anxiety, esophageal reflux, and costochondritis. In Hawaii, her exam was remarkable only for tenderness to palpation over the left and right costochondral junctions. Since she reported very little milk intake or sun exposure, a serum 25-OH Vitamin D (25-OHD) level was obtained and returned at 42 nmol/L (17 ng/mL), consistent with deficiency. She was started on Vitamin D, 1000 international units (IU) daily. On 3-month followup, her repeat serum 25-OHD was 72 nmol/L (29 ng/mL) and she had complete resolution of her chest pain.

Case 2. A 42-year-old Asian female with historcarotid Doppley of hypertension and hyperlipidemia presented to a Hawaii emergency department with complaints of substernal chest pain. She was admitted to the hospital for a rule-out myocardial infarction protocol. In the hospital, she was found to have marked tenderness along the left costochondral junction. She did not routinely drink milk and despite living in Hawaii, she reported little sun exposure due to her work hours. After ruling out for myocardial infarction, she was discharged with followup for a treadmill stress test, which was normal. Prior to her discharge, a serum 25-OHD level was drawn to rule out vitamin D deficiency. On followup, her vitamin D level returned 27 nmol/L (11 ng/mL) and she continued to report chest pains. She was started on oral Vitamin D₂ 50,000 IU once a week for 8 weeks and maintained on 1,000 IU a day thereafter. Repeat 25-OHD level 2 months later was 82 nmol/L (33 ng/mL). Her chest pain resolved with treatment.

3. Discussion

In this paper, both patients had extensive workups done with concern for cardiac disorders but were eventually diagnosed with costochondritis and vitamin D deficiency. We hypothesize that these patients’ costochondritis may have been related to vitamin D deficiency. Vitamin D is integral for bone health, and serum 25-OH vitamin D (25-OHD) is predictive for body stores of vitamin D [7–9]. While there is controversy over what defines deficient or optimal serum levels of 25-OHD, levels less than 50 nmol/L (20 ng/mL) lead to increase in bone turnover markers and increase in parathyroid hormone (PTH) [10]. Another study found that defective bone mineralization was evident in patients with serum 25-OHD less than 75 nmol/L (30 ng/mL) but none above that threshold [11]. The recent Institute of Medicine report found evidence that a serum 25-OHD level above 50 nmol/L (20 ng/mL) is generally sufficient for bone health for 97.5% of the population. Hence, a 25-OHD level less than 50 nmol/L (20 ng/mL) is generally considered consistent with vitamin D deficiency [7, 8]. Severe vitamin D deficiency, defined as a 25-OHD less than 25 nmol/L (10 ng/mL), can cause rickets in children and osteomalacia in adults [12]. Rickets classically causes “bow legs” or “knock-knees” due to disordered growth along weight-bearing bone. “Rachitic rosaries” describes hypertrophied costochondral junctions in relation to defective mineralization [13, 14]. Osteomalacia, the adult version of rickets, can cause diffuse bone pain. Tenderness to the anterior tibia, sternum, and costochondral joints can indicate osteomalacia and vitamin D deficiency [14, 15]. Although bone biopsy is the gold standard for osteomalacia, it is not generally practiced. Bone pain and vitamin D levels less than 25 nmol/L (10 ng/mL) are often sufficient for the clinical diagnosis of osteomalacia.

Although both patients did not have had levels less than 25 nmol/L (10 ng/mL) to suggest osteomalacia, we theorize that milder forms of vitamin D deficiency can cause a spectrum of pain along the sternum and costochondral junctions similar to patients with rickets and osteomalacia. Costochondritis continues to be a poorly defined entity but may represent a milder, earlier form of osteomalacia associated with higher serum 25-OHD levels. Importantly, osteomalacia and vitamin D deficiency may not be considered when a patient presents with complaints consistent with costochondritis, as testing for vitamin D deficiency in these patients has not been reported, nor is it routine.

A review of the literature revealed no reported cases of costochondritis associated with vitamin D deficiency, and only a few case reports of chest pain associated with vitamin D deficiency. One case described chronic chest and leg pain of 2 years duration in a 34-year-old female [4]. After two years of conservative treatment with anti-inflammatory medications, she was eventually diagnosed with osteomalacia associated with aluminum-containing antacid use. Aluminum containing antacids may cause osteomalacia by binding to phosphate, causing a negative phosphate balance and eventual disordered bone growth. However, there was no serum 25-OH vitamin D (25-OHD) level measured to support the diagnosis of osteomalacia. She improved with vitamin D supplementation and decreased antacid use. Another case reported a 37-year-old Indian living in Germany who was subsequently diagnosed with vitamin D deficiency and osteomalacia. Chest pain was the only presenting symptom. His 25-OHD level was undetectable. He was started on high-dose vitamin D and then maintenance vitamin D with resolution of his chest pain [5]. Lastly, a 21-year-old Turkish female living in Germany presented with left-sided chest pain with unremarkable electrocardiogram, troponin and d-dimer [6]. Her 25-OHD level was 9 nmol/L (4 ng/mL), and she was diagnosed with osteomalacia causing her chest pain. Treatment with vitamin D, calcium, and calcitonin resolved her symptoms in two months. These case reports are suggestive of osteomalacia and severe vitamin D deficiency as the cause of chest pains. It is possible that the spectrum of bone pain, including costochondritis, may be correlated to the degree of vitamin D deficiency.

In our paper, both patients were at significant risk for vitamin D deficiency despite living in an area with abundant sunshine. Vitamin D can only be obtained through ultraviolet light exposure, vitamin-D-rich foods, and supplementation. Both patients reported little to no milk intake, no other vitamin supplementation, and little sun exposure, putting them at high risk for deficiency. The IOM recently increased the recommended daily allowance (RDA) of vitamin D for adults from 400 IU to a minimum of 600 IU in order to maintain 25-OHD levels above 50 nmol/L (20 ng/mL) for 97.5% of the population [7]. However, other expert recommendations have suggested much higher levels of vitamin D, ranging from 400 to 2000 IU daily to maintain adequate serum 25-OHD; depending on risk factors present [8, 9]. Sun exposure can provide the most efficient means of maintaining vitamin D stores; however, dark-skinned individuals absorb less ultraviolet radiation from sunlight and thus convert less 7-dehydrocholesterol into vitamin D. People living at higher latitudes are at increased risk for deficiency, but studies show that even in areas with adequate sunshine, vitamin D deficiency can be highly prevalent [16, 17].

Our paper has clear limitations. With prevalence of vitamin D deficiency reported to be up to 36% in young adults [12], costochondritis may be merely an unrelated association. However, with treatment of deficiency and normalization of their serum vitamin D, both patients’ costochondritis improved, further supporting vitamin D deficiency as a potential cause of their costochondritis. The improvement of symptoms may also be attributed to self-limited costochondritis rather than the vitamin D supplementation. However, it is notable that once adequate treatment was initiated, no further cases of chest pains have been reported—including the patient who had 3 years of chronic chest pain. This further strengthens our hypothesis that vitamin D deficiency may be a cause of costochondritis. We recommend further prospective studies, specifically in primary care, to help elucidate the association of vitamin D deficiency and costochondritis.

4. Conclusion

In patients with costochondritis, or bony sternal pain, physicians should consider vitamin D deficiency and osteomalacia and elicit any risk factors for deficiency. Patients with costochondritis who are at risk for vitamin D deficiency should be tested with a serum 25-OHD level and treated if found to be vitamin D deficient. Studies looking further at the association of costochondritis and vitamin D deficiency are warranted.

Conflict of Interests

The authors declare no conflict of interests.

Disclaimer

The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

Disclosure

This paper was presented as an oral case presentation at the Uniformed Services Academy of Family Physicians Annual Conference, New Orleans, LA, February 2010.

90,000 Cervical spondylosis, causes, symptoms and treatment

Neck pain can have many causes. But in many cases, the pain comes from old age. Like other bones in the body, the bones of the spine degenerate with age and cause various problems in the structure of the spine. If this injury occurs in the neck, it is called cervical spondylosis.

Cervical spondylosis is very common. More than 85% of people over 60 years old suffer from this disease. This condition often causes neck pain and stiffness.Acquaintance with the symptoms, methods of prevention, treatment and prevention of the growth of this disease will improve the quality of life of people.

Neck spondylosis and pain site

The spine is made up of 24 bones called the vertebrae, which form a protective channel for the spinal cord. Among these 24 vertebrae, seven vertebrae that begin at the base of the skull include the neck and are known as the cervical spine. Spondylosis is neck pain that occurs in this part of the spine.

What are the most important causes of neck osteoarthritis?

Cervical spondylosis is caused by age-related changes in the bone tissue of the spine. These changes are completely normal and occur in all elderly people. About half of middle-aged and older people have degenerative bones in the spine but do not have irritating or painful symptoms. Some of the most important causes of cervical spondylosis are:

Disk degeneration

As we age, the intervertebral discs in the spine lose their thickness and deform.In some cases, the water inside them dries up and its thickness decreases. In this case, the lateral pressure of the discs and vertebrae gradually increases, causing destruction and spondylosis of the neck.

Herniated disc

Natural aging can cause the outer part of the spinal disc to crack. In this condition, the inside of the disc is removed, which is called a herniated disc or herniated disc. A hernia puts pressure on nearby tissue or a spinal nerve, and this pressure is the main cause of pain, tingling, or numbness.

Osteophyte

Smooth and slippery articular cartilage covers and protects joints. This cartilage will also gradually wear out as you age. If the cartilage is completely worn out, the bones can wear against each other. To replace the lost cartilage, new bone is made to support the vertebrae instead of joints. Over time, this bone grows so large that it is called a bone spur. Overgrowth of bone spurs can narrow the passage of the nerves and spinal cord and cause cervical spondylosis.

Neck injuries

Neck injuries from accidents such as falls or accidents can lead to more rapid destruction of the vertebrae and premature aging, leading to osteoarthritis of the neck.

Ligament stiffness

Ligaments are strong cords that connect the bones of your spinal cord. If the ligaments tighten over time, they will interfere with the movement of your neck, causing pain and cervical spondylosis.

Excessive pressure on the neck

Certain types of work or sports involve repetitive, heavy neck movements that place additional stress on the spine, leading to premature neck wear and osteoarthritis.

Who is most at risk for cervical spondylosis?

Older people are more likely to suffer from cervical spondylosis, because it is associated with old age. But other people are also susceptible to disease. Including:

• Those who smoke.
• Depressive and anxious people
• People with genetic origin
• People with a history of previous trauma in an accident
• Construction painters who stare at your head for hours every day, or plumbers and floor installers who keep their heads down for a long time.
• People who hold their head in an uncomfortable position for a long time, for example, stare at a computer screen for a long time.
• Builders are doing hard work.
• Bus or truck drivers who are exposed to vibration for a long time.

Recognize the symptoms of cervical spondylosis

Cervical spondylosis is asymptomatic for most people, but it usually presents with neck pain and stiffness if symptoms do occur. This pain can be mild or severe.

Sometimes the pain increases when you look up, look straight ahead, or perform activities that require your neck to remain in this position for a long time, such as driving a car or reading a book.These pains are worse when resting or lying down.

But other symptoms may indicate osteoarthritis of the neck. Such as headache, dizziness, splitting sound when turning, muscle spasms in the neck and shoulders.

A common symptom of cervical spondylosis is pain around the scapula. Some people complain of pain in the hand and fingers. This pain may worsen when standing, sitting, sneezing, coughing, and bending the neck back.

In some cases, cervical spondylosis leads to narrowing of the spinal cord and nerve roots.In this case, it will be accompanied by symptoms such as numbness and weakness in the arms, hands and fingers, difficulty walking, loss of balance, lack of control over urination and defecation, weakness in the arms or legs.

Methods for the diagnosis of cervical spondylosis by doctors

When a person comes to an orthopedist with neck pain, at the first stage, after a medical history, the doctor conducts clinical examinations of the shoulders, neck, arms and legs. It tests hand and finger strength, touch strength, reflexes, blood flow, gait balance, and more.He then compiles a history of pain.

In a second step, the doctor may order diagnostic tests to make sure the patient has cervical spondylosis. These tests include the following.

• X-ray shows neck bones, alignment, bone loss and bone spurs.
• Computed tomography (CT) scans provide more detail than X-rays. This scan will help you see your spinal cord and bone spurs better.
• MRI scans show details of soft tissues such as cartilage, nerve roots, muscles, spinal cord and discs.This test can show a compression of the spine or a herniated disc more clearly than x-rays. MRI electromyography can help determine the source and location of pain.
• Other tests may include myelograms (computed tomography) or electromyograms (tests of nerve function). These tests provide more detailed information about the effect of cervical spondylosis on your nerves.

Treatment of cervical spondylosis

When a doctor diagnoses cervical spondylosis, patients are prescribed different treatments depending on the severity of the disease.

Non-surgical treatment

In most cases, the treatment of cervical spondylosis is nonsurgical.

In the first phase of treatment, the doctor prescribes several medications to relieve both pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are often prescribed along with acetaminophen to relieve pain. Medicines such as cyclobenzaprine or carisoprodol are used to treat painful muscle spasms.

Physiotherapy is a non-surgical treatment option that doctors recommend.Special exercises can help relieve pain and strengthen and stretch weak muscles.

Home treatments for cervical spondylosis include the use of neck guards, which restrict neck movement, and massage, hot and cold compresses to relieve pain.

Steroid injections are also one way to reduce inflammation and neck pain, which is very rare and is recommended by doctors for certain conditions.

Surgical treatment

Surgical treatment is not usually used for cervical spondylosis unless the condition is specific.For example, when the spinal cord and nerves are under pressure and the patient has progressive neurological symptoms such as hand weakness and anesthesia.

Surgery may also be recommended if you have severe pain that does not go away with nonsurgical treatment. However, some patients with severe neck pain will not be candidates for surgery, which may be due to the common nature of their osteoarthritis, other medical problems, or other causes of their pain, such as fibromyalgia.

How can cervical spondylosis be prevented?

Cervical spondylosis caused by aging cannot be prevented, but you will reduce your risk of developing it if you follow some guidelines.

• Try to be in your best physical position when standing, sitting and sleeping
• Exercise regularly When exercising, always use appropriate sports equipment under. supervised by a trainer.
• Beware of blows to the neck.

Facts About Cervical Spondylosis

Cervical spondylosis is more common in older people, but in many cases there are no symptoms and the person will never notice the disease.

Patients with cervical spondylosis usually do not have disabilities and do not need severe treatment, and if pain occurs, it can be treated with physical therapy and certain medications. But sometimes changes in the spine can compress the spinal cord or the nerve roots attached to it, in which case the person will suffer from numbness, imbalance, and similar problems.In these cases, doctors use surgical techniques to solve the patient’s problem, which is very rare.

90,000 Why Doctors Don’t Take Women’s Pain Complaints Seriously

• Jennifer Billlock
• BBC Future

May 27, 2018

Photo Credit, Getty Images

Pidpis to photo,

Doctors often ignore women’s pain complaints

Women have to wait longer in emergency departments and are more likely to be denied effective pain relief than men . D really Whether women and men experience pain differently, explains the BBC Future columnist, who herself suffered from gender stereotypes of doctors.

In 2009, my doctor told me that, like most women, I listen too much to my body. Explaining that I have no health problems, he advised me to relax and not pay attention to unpleasant symptoms.

His conclusion did not seem to account for the entries in my medical record.Just a few weeks ago, I ended up in the ER with chest pain and a heart rate of 220 beats per minute.

The ambulance doctors, however, said it was a panic attack, gave me Zanax (a drug from a group of tranquilizers) and sent me home to bed.

I’ve had panic attacks before, but I felt like this time it was something different. I went to my doctor.

He connected me to a heart monitor for the night, and the device recorded another panic attack.I went home, trying to ignore the pain.

Author of the photo, Getty Images

Pidpis to the photo,

“I was told that the cause of pain in my heart is anxiety, and they sent me home”

But the attacks were repeated again and again. Monthly first, then weekly.

For the next nine years, to my complaints, I heard the same answer – panic attack, women do not experience heart pain as I described it, I was just wrong.

• How to avoid missing a heart attack?

My experience, however, was not exceptional.

The author of Ask Me About My Uterus, Abby Norman, had a similar journey before she was diagnosed with endometriosis (a painful condition where cells in the inner layer of the uterus invade other organs).

Several doctors told her that she had a urinary tract infection until she went to see her boyfriend, who confirmed that she was in severe pain.

Norman writes that she was also diagnosed with appendicitis.One doctor even suggested that childhood sexual abuse was the cause of the symptoms, although Norman absolutely denied this.

Both life stories and scientific studies point to an alarming trend: physicians often overlook women’s complaints of pain, a relationship that has been around for quite some time.

Is it related to gender bias, lack of research on this topic, or actual differences in how women and men respond to pain symptoms?

Probably we only know that doctors have different attitudes towards complaints of pain in women and men.

One study, for example, found that women who complained of acute pain were less likely to be prescribed opioid (most effective) pain medications in the emergency department than men.

Even after receiving appointments, women had to wait longer.

Another 2014 study in Sweden found that emergency doctors generally take women’s pain complaints less seriously than men.

This is sometimes fatal.In May 2018, in France, a 22-year-old woman called an ambulance and said that her stomach ached so badly that she thought she “could die.”

The operator told her that “one day she will indeed die, like the rest of us.” When the woman was taken to the hospital five hours later, she suffered a stroke and died from multiple organ failure.

Photo by Getty Images

Sign up to photo,

In trauma and emergency departments, women have to wait much longer than men

“The fact that emergency departments treat women differently than men has long been known.” says Esther Chen, a resuscitator at the Zuckerburg Health Center in San Francisco and co-author of a study on opioid pain medications.

In her research, she addresses the problem of acute abdominal pain. Emergency doctors often assume that in women this pain is related to gynecology.

According to many doctors, this condition, unlike acute surgical diseases, does not require opioid pain relievers.

In addition, women are more likely to be prescribed sedatives when they go to the hospital with pain. And the cause of unpleasant symptoms in them is more often believed to be mental disorders.

Photo author, Getty Images

Sign up to photo,

Instead of being referred for tests, women are more likely to be sedated or sent to a psychiatrist

Christine Wesley, co-founder and head of the Chronic Pain Research Alliance, is thrilled by the number of misdiagnoses and strange advice.

“Women tell outrageous things that doctors have told them. You have problems in your marriage, or that a glass of wine before sex will help. And the list goes on,” says Wesley.

“It’s hard to imagine that this is said by people who took the Hippocratic Oath,” she adds.

This attitude is apparently due to the assumption that women tend to complain more about medical problems than men.

Indeed, one British study found that men were one third less likely to see a doctor than women.

However, according to other sources, with the two most common types of pain, in the back and head, men and women go to the doctor with the same frequency.

Author of the photo, Getty Images

Signs before the photo,

One of the doctor’s advice to a patient who complained of pain: “Drink a glass of wine before sex”

Many studies from 1972 to 2003 show that women tolerate pain worse than men. Cultural gender norms probably contribute in part to this.

Studies also show that women are more likely to see their doctor with anxiety-like symptoms and are more prone to opioid dependence, says Karen Siebert, president of the California Anesthesiology Union.

So it seems like a good practice to prescribe a sedative first before moving on to more serious pain relievers, Siebert explains.

“When you are anxious, your ability to tolerate pain is reduced,” she adds.

Photo author, Getty Images

Signs up to photo,

Studies have shown that women have a lower pain threshold than men

Complicating the situation is the fact that estrogen alters both the perception of pain and the response to pain medication, says Nicole Voitovich from the Institute for Women’s Health Research.

This means that “there really is a difference between how women and men feel pain,” says the specialist. And therefore, doctors must take an individual approach to patients of different genders.

Is there a difference?

However, more research is needed to pinpoint these differences – and their impact on treatment.

Until 1990, when the US National Institutes of Health opened a division to research women’s health, clinical trials and diagnoses focused primarily on men.

Mainly men also supervised the research. A similar situation was observed in Europe, in particular in the UK, and in Canada.

Author of the photo, Getty Images

Signs to the photo,

Men and women experience pain in different ways

As a result, a huge amount of medical data, including the results of laboratory studies of pain, mainly concerns men.

“When case histories, particularly textbook cases, are written primarily by men and about men, it becomes the yardstick against which everyone is compared,” explains Abby Norman.

Only in 2015, the US National Institutes of Health required physicians to take into account the sex of a person as a biological variable in research.

Now everyone who applies for a grant to the Institute must either conduct a medical research on the example of both sexes, or convincingly justify why the analysis will only apply to one sex.

Of course, we will only be able to know in a few years whether this policy will be effective in action.

Photo by Getty Images

Signs up to photo,

When everything doctors know about a disease is based on research on men’s health, men’s symptoms become the yardstick against which women’s feelings are compared

Similar rules were recently introduced by the UK’s National Health Service.

Canada and the EU introduced them back in the early 2000s, but in the form of recommendations, not requirements.

However, this still does not avoid the preconceptions about women’s pain, often inherent in doctors and other health professionals.

Canadian researchers from McGill University even managed to prove that patients of both sexes with more “feminine” personality traits risk not receiving timely and adequate medical care.

Study co-author Louise Pilot explains why my heart problems have been neglected for so long.

Heart disease is less common among women than men. In females, they begin later.

In addition, when women visit a cardiologist, they often describe symptoms other than chest pain, she explains.

Author of the photo, Getty Images

Pidpis to photo,

Heart disease is less common among women than among men

Indeed, I was worried about the symptoms I experienced due to chest pain and fast heartbeat – dizziness and shortness of breath.Now I understand why the doctor could mistake these sensations for an ordinary anxiety attack.

In January 2018, I finally found a cardiologist, a woman who solved my problem. I again underwent cardiac monitoring, received an official diagnosis – and in March I underwent surgery.

I may have waited almost 10 years for treatment as heart disease is less common in women. Perhaps because my symptoms really looked like a textbook example of anxiety.

Or perhaps the issue is gender bias, which claims that women are more likely to complain of pain, but less likely to have physiological reasons for it.

On the other hand, even if my gender was the cause of the misdiagnosis, it is almost impossible to prove it.

You can read and the original of this article in English on the website BBC Future .

Follow our news on Telegram!

Chest pain. Reasons – Actual – Penza View

Olga Shulemyatyeva, a cardiologist at the City Polyclinic of Polyclinic No. 4, spoke about common problems.

The main complaint of patients at a cardiologist’s appointment is chest pain. Quite often, chest pains occur with the pathology of other organs and systems and are not associated with the pathology of the heart. Olga Shulemyat’eva, a doctor at the City Polyclinic at the City Polyclinic of Polyclinic No. 4, spoke about the most common causes and characteristics of pain.

Angina attack

Pain occurs behind the sternum, it is squeezing, squeezing, sometimes cutting, but never sharp, but always dull.A person cannot indicate exactly where it hurts, and puts his hands on his entire chest. The pain radiates to the area between the shoulder blades, to the left arm, jaw, neck. Usually appears during emotional stress, physical exertion, when going out into the cold from a warm room, while eating, at night. When the heart hurts, the discomfort lasts from a few seconds to twenty minutes. Usually the patient freezes in place, he has shortness of breath, a feeling of lack of air, a feeling of fear of death. Significant relief or complete relief of the attack occurs immediately after taking nitroglycerin.Heart pain does not depend on the position of the body, inhalation or exhalation.

Myocardial infarction

Sudden sharp pain behind the sternum of a pressing or burning character, radiating to the left side of the chest and back. The patient has a feeling that a very heavy burden is on the heart. A person experiences a sense of fear of death. With a heart attack, breathing quickens, while the patient cannot lie down, he tries to sit up. Unlike angina pectoris, heart attack pain is very sharp and can be aggravated by movement.Often not stopped by nitroglycerin, a short-term effect is possible.

Inflammatory heart disease

Heart pain occurs during inflammatory processes such as myocarditis and pericarditis.

With myocarditis, the sensations are almost the same as with angina pectoris. The main signs are aching or stabbing pains radiating to the left shoulder and neck, a feeling of pressure behind the sternum, usually slightly to the left. They are almost continuous and long-lasting, and can increase with physical exertion.Nitroglycerin does not relieve pain. Patients suffer from asthma attacks and shortness of breath during physical work and at night, swelling and pain in the joints are possible.

Signs of pericarditis – moderate dull monotonous pain and fever. Painful sensations can be localized in the left side of the chest, usually above the heart, as well as in the upper left side of the abdomen, left shoulder blade. They increase with coughing, with a change in body position, with deep breathing, while lying down.

Aortic dissecting aneurysm is characterized by severe bursting pains behind the sternum, which may be followed by loss of consciousness. Emergency assistance required.

Pulmonary embolism

An early sign of this serious illness is severe chest pain that worsens with inhalation. Resembles angina pain, but does not radiate to other parts of the body. Doesn’t go away with pain relievers. The patient experiences severe shortness of breath and palpitations. There is cyanosis of the skin and a rapid decrease in pressure.The condition requires immediate hospitalization.

Pain of non-cardiac origin

Intercostal neuralgia

Intercostal neuralgia is very often mistaken for heart pain. It really resembles angina pectoris, but there are significant differences. Neuralgia is characterized by a sharp shooting pain, which is aggravated by movements, turning the body, coughing, laughing, inhaling and exhaling. The pain can go away quickly, but it can last for hours or days, getting worse with each sudden movement.The pain is localized pointwise to the left or right between the ribs, the pain can be given directly to the heart, lower back, back or spine. Usually, the patient can pinpoint the location of the pain.

Osteochondrosis

With thoracic osteochondrosis, a person experiences pain in the heart, which radiates to the back, up the abdomen, scapula and intensifies during movement and breathing. Feeling of numbness in the interscapular region and left arm is possible. Many people mistake their condition for angina pectoris, especially if the pain occurs at night and there is a feeling of fear.You can distinguish heart pain from osteochondrosis by the fact that in the latter case, nitroglycerin does not help.

Diseases of the digestive system

Pain in the chest usually occurs due to muscle spasms of the stomach walls. Symptoms such as nausea, heartburn, and vomiting will help to find out their true origin. These pains are longer than heart pains and have a number of characteristics. Depend on food intake: for example, appear on an empty stomach and disappear after eating. Nitroglycerin does not help in such conditions, but antispasmodics are effective.

Severe pain with a hernia of the esophagus (apertures of the diaphragm) resembles angina pectoris. It appears at night when a person is in a horizontal position. It is worth taking an upright position, the condition improves.

For information on what kind of help the heart needs in winter, read here .

90,000 Which bones break most often

Rib fractures are dangerous if something is pierced inside

Ribs are the first to be mentioned in the Bible.They are involved in the creation of the human race. Despite such a prominent role of these bones, they are considered quite fragile. At least they break quite often. According to the statistics of traumatologists, in every twentieth case of fractures, it is the ribs that fall. Moreover, the taller a person is, the higher the likelihood of injury.

Ribs don’t break for no reason. They crack when dropped, directly hitting the chest, after squeezing the chest. A fracture of one rib is called isolated, a fracture of several ribs is called multiple.According to the degree of trauma, a rib crack, a subperiosteal fracture is distinguished, when bone tissue breaks, and the periosteum remains intact, as well as a complete fracture. In any case, the fracture itself is considered not dangerous by traumatologists. It heals quickly enough. And the danger is posed by possible concomitant damage to internal organs. It is necessary to be afraid of them.

Rib fractures are often complicated by damage to the membrane of the lungs – the pleura and the lungs themselves. With such damage, the likelihood of hemothorax is high (accumulation of blood in the chest cavity between the inner and outer membranes of the lungs), pneumothorax is the accumulation of air in the chest cavity.Sometimes air from the lungs enters the subcutaneous tissue. This is also bad. This is called subcutaneous emphysema.

Most often, fractures occur in the place of the greatest bend of the ribs – along the lateral surface of the chest. If one rib is broken, there is usually no displacement of the fragments. With multiple fractures, the fragments can move in different directions, injure nearby tissues and organs and cause all sorts of complications. In such cases, the victim is worried about chest pain, which increases with deep breathing, coughing, talking.The pain may decrease while the patient is sitting and increases with movement.

With multiple fractures with damage to the lungs, the patient usually sits motionless, breathing shallowly. When the surgeon probes the chest, a sharply painful fracture site is found. In case of damage to the lung tissue and the release of air into the subcutaneous tissue, a specific creak of fatty tissue under the fingers is felt during palpation. This symptom is called crepitus. The condition of a person with multiple fractures is quite serious.His breathing, the rhythm of heart contractions may be disturbed. The skin becomes pale with a bluish tinge. If fragments of ribs damage lung tissue, hemoptysis occurs. Multiple rib fractures are often complicated by the development of pneumonia.

Treatment of the patient begins after X-ray examination. For isolated and uncomplicated rib fractures, anesthesia is performed at the fracture site. For this, local novocaine or alcohol-novocaine blockades are used in the area of ​​the fracture of each rib.The patient is recommended to sit in bed, breathing exercises, expectorant drugs, physiotherapy treatment aimed at preventing congestion in the lungs and improving their ventilation are also prescribed.

Isolated and uncomplicated rib fractures often do not require hospitalization and patients can be treated on an outpatient basis. In uncomplicated fractures, it usually takes about one month for the ribs to heal.

Multiple and complicated fractures require rib fixation and traction in order to restore the integrity of the chest and normalize the breathing process.Therefore, the patient is left in the hospital ward. To eliminate the compression of the lungs with air or blood in pneumothorax and hemothorax, puncture of the chest cavity is performed, and air or blood is removed mechanically. Sometimes punctures have to be performed several times. In especially severe cases, artificial lung ventilation is used. But the patient is saved anyway.

Gleb SIVEROV

Subscribe to news

90,000 Not childish: shortness of breath turns out to be the main symptom of severe COVID-19 in a child | Articles

Chinese scientists have identified 11 signs of possible complications of COVID-19 in children .The most obvious signs were shortness of breath, abnormal chest x-ray, and a runny nose. The list also included comorbidities, fever, fever, cough, diarrhea, poor computed tomography of the lungs, changes in the concentration of C-reactive protein and the enzyme lactate dehydrogenase. The data obtained on the course of coronavirus infection in children formed the basis for a mathematical model that predicts the likelihood of developing severe COVID-19 in young patients. The information can be used for 90,019 90,020 early diagnosis and relief of disease manifestations and complications, experts say.

Divination by symptoms

A group of scientists from the Peking University of Chinese Medicine investigated the risk factors for a severe course of coronavirus infection in children . Experts have found 11 signs that indicate a high likelihood of COVID-19 becoming severe. The most obvious manifestation of future problems was shortness of breath, which occurs with complications twice as often as other symptoms . There is also a clear indication of the danger of abnormalities on chest x-ray and runny nose.Based on the data obtained, scientists have created a mathematical model that calculates the risks of adverse development of disease. You can find out the prognosis by entering information about the patient’s age and symptoms.

“Data on the development of the pandemic show that children are less susceptible to severe COVID-19 than adults. However, Chinese studies suggest that infants and young children have a higher chance of severe coronavirus infection compared to older children due to an underdeveloped immune system, “the study authors wrote in an article in Nature.

Photo: RIA Novosti / Evgeny Biyatov

Scientists studied data on the development of coronavirus infection in 203 children. 26 of them were asymptomatic, 160 were mild, 15 were severe. Comparing the information on the symptoms in each of the groups, doctors came to the conclusion that 90,460 warning signs in the development of COVID-19 include the presence of concomitant diseases, fever, high temperature, cough, runny nose, shortness of breath, diarrhea, abnormalities on chest x-rays and computed tomography lungs, deviations from the norm in the concentration of C-reactive protein (a blood plasma protein, the concentration of which increases during inflammatory processes) and the enzyme lactate dehydrogenase (an increased indicator indicates the destruction of body tissues in various diseases, including problems with the lungs).

It is significant that a negative lung x-ray during the study showed a significantly more significant association with the severe course of coronavirus infection compared with computed tomography of the lungs.

– Indeed, a poor X-ray of the lungs suggests that the situation is difficult, while some lesions on a more sensitive computed tomography of the lungs may not affect the patient’s clinical manifestations in any way, – the research professor of the Immanuel Baltic Federal University explained to Izvestia Kant (the university is a participant in the project to improve the competitiveness of education “5-100”) Andrey Prodeus.

Photo: Depositphotos

Chinese scientists had to exclude some symptoms from the calculations, since they were unable to obtain accurate quantitative values ​​for them, which are necessary for reliable predictions. For this reason, , along with age, only data on the presence of concomitant diseases, cough, shortness of breath, the concentration of C-reactive protein and lactate dehydrogenase were included in the final mathematical model for practical use.Within the framework of the model, each of the signs was assigned a certain number of points, depending on its connection with the course of the disease. The higher it is, the more points are assigned to the symptom.

For example, a 9-year-old child (5 points) with concomitant diseases (11 points), cough (5 points), shortness of breath (92 points), C-reactive protein concentration 30 mg / ml (45 points) and lactate dehydrogenase 200 mg / ml (8 points) has a 99% chance of carrying severe COVID-19.

Also, the calculations of Chinese scientists showed that 7.5% of children suffer from a severe form of coronavirus infection, and 12.9% of them are asymptomatic.In adults, these figures are 26–32% and 1%, respectively.

Not only at COVID -19

The set of symptoms described in the article by Chinese scientists, and in particular shortness of breath, can be considered signs of a severe course of COVID-19 in children, Russian experts interviewed by Izvestia agree.

– Dyspnea is, first of all, a sign of pneumonia , – explained to Izvestia the deputy director for scientific work of the Federal Budgetary Scientific Institution of the Central Research Institute of Epidemiology of Rospotrebnadzor, Corresponding Member of the Russian Academy of Sciences Alexander Gorelov.

The specialist recalled: according to the WHO criteria, which have been adopted since the late 1970s, an increase in the number of respiratory movements to a level of 1.5–2 times more than the norm indicates that the patient has complications, and most often it is lung damage.

According to the scientist, a runny nose is mistakenly included among the warning symptoms of COVID-19, since it is not a differential diagnostic sign of . But changes in radiography can be significant for the diagnosis, Alexander Gorelov pointed out.This study is the next step if a child develops shortness of breath and fever for more than three days without a tendency to decrease, he noted.

Photo: RIA Novosti / Evgeny Biyatov

Professor-researcher Andrey Prodeus also agrees with his colleague.

– Basically for any conditions and pneumonia, not only associated with COVID-19, it is respiratory failure that is one of the most important symptoms .And shortness of breath is a consequence of respiratory failure. When there is not enough oxygen supply to organs and tissues, such a problem arises, – he said.

According to the physician, the main value of the scientific work is that the authors presented statistics on the frequency of painful manifestations in COVID-19 in children.

The described symptoms will allow 90,019 90,020 early diagnosis and prescribing supportive, including respiratory, therapy that can reduce the severity of the disease and mortality from it , says a researcher at the Laboratory for the Analysis of Population Health Indicators and Digitalization of Healthcare at the Moscow Institute of Physics and Technology, junior researcher of the laboratory experimental surgery and oncology of Kursk State Medical University David Naimzada.

Pectoralis Minor Syndrome – Cause of Soreness, Numbness and Swelling of the Hands | Health

Pectoralis minor syndrome is a major cause of pain, swelling and numbness in the hands. But also the causes of numbness can be tunnel syndrome, osteochondrosis, diabetes, side effects from taking various medications and others, therefore, in the presence of such a symptom, examination is mandatory.

The pectoralis minor muscle is located under the pectoralis major muscle, extending from the third, fourth and fifth ribs up to the process of the scapula.It is thanks to this muscle that we can move the scapula down, up or to the sides. Also, this muscle is involved in the formation of posture and prevents stoop in the shoulders. But if a person spends most of the time in a sitting position with a hunched back, this provokes overstrain of the pectoralis minor muscle, which is fraught with serious disorders, in particular, compression syndrome of the chest opening.

What is pectoralis syndrome

This syndrome develops when the blood vessels and nerves in the chest and front of the shoulders are severely pinched.The following symptoms are observed:

• skin discoloration;
• edema appears;
• fingers or hands are completely numb;
• increasing pain is felt;
• shoulders are constantly bent forward;
• Feeling of lack of air often occurs.

Subscribe to our INSTAGRAM account!

Symptoms usually appear at night, but over time they begin to bother during the day, especially if you do not change your posture for a long time.

In the syndrome, the pectoralis minor muscle is shortened, which provokes restriction of respiratory movements, impaired blood circulation, weakening of liver function and other problems. A weak and stretched muscle is easy to injure, and over time, so-called trigger points appear, which not only interfere with the normal functioning of the muscle, but also its recovery.

How to treat pectoralis minor syndrome

If you do not take timely measures, overstrain of the pectoralis minor muscle can provoke a disruption in the muscles of the neck, lower back and hip region.

To eliminate the problem, it is initially necessary to restore the mobility of the joints located at the level of the seven vertebrae of the thoracic spine. To do this, you should contact a professional massage therapist or use special massagers, for example, in the form of rubber dumbbells with spikes.

Follow Econet on Pinterest!

Then the back muscles should be developed with strengthening exercises involving the use of massage or tennis balls.You should work with the balls while standing against the wall, performing movements in different directions (down, up, right, left, in a circle) with different pressure on the back, especially working on painful areas. After developing the muscles, you can proceed to the following exercises:

1. In a standing or sitting position, lower your arms, bring your shoulder blades together and then relax. The exercise should be performed slowly, in total, you need to do three approaches at least fifteen times twice a day.

2. As in the previous exercise, you need to bring the shoulder blades together, but at the same time bend your arms at the shoulders at a right angle and also move the shoulder blades.Three sets of fifteen times will be enough.

3. With the shoulder blades brought together, put your hands behind the back of your head and fasten your fingers into the lock. Also move your shoulder blades, do three sets of fifteen times.

4. Lie face down, stretch your arms at an acute angle, raise your thumbs up, then raise your arms, hold them for a few seconds and lower them. Three sets of twenty seconds are enough. Then you should rest for half a minute and repeat the exercise first for the right, then for the left hand, then for both hands at the same time.

Subscribe to our Yandex Zen channel!

5. Lie face down on the edge of the bed with your arm hanging down and your head turned towards this arm. Raise your arm at a sharp angle. Perform three approaches twenty times without weights, and after a couple of weeks repeat with 3, 0.5 and 1 kg weights.

After training, you need to directly develop the pectoralis minor muscle and determine the presence of trigger points – just massage the muscle with the opposite hand and, if painful areas are identified, perform a massage with a ball until the pain disappears.After that, you need to stretch the muscle – stand in the doorway, lean on both sides of the jamb with your forearms or hands so that your elbows are above your shoulders and bend forward, lingering for half a minute. Do a couple of these approaches and repeat everything twice during the day. The main thing is to bend the chest well, and leave the head and pelvis motionless. Or you can do another exercise: stand against a wall, lean on it with your hand so that the elbow is at eye level, turn the body in the opposite direction, without lifting your hand, so that you feel a good tension of the pectoral muscle.

The best publications in the Telegram channel Econet.ru. Subscribe!

To consolidate the result, work out the upper trapezoid: stand or lie down, put your left hand behind your back, and put your right hand on the crown, tilt your head back, then forward. The exercise should be performed slowly, gradually increasing the muscle tension. Regular training will allow not only to get rid of the syndrome, but also to align the posture.