Sore Jaw, Shoulder Pain. Blood Work, EKG, Stress Echo Normal. History Of Anxiety. Further Testing Required?

Posted on Fri, 12 Apr 2013

Question: Hi. 29 year old female. Not overweight. Eat healthy. Don't exercise much. Occasional smoker Have been feeling very sore jaw and left shoulder pain. Had 2 EKG"s blood work twice. Normal stress echo. No history of heart problems. Should I suggest further testing? Is this stress? I have suffered bad anxiety for about 10 years. Always worry.

Answered by Dr. Seikhoo Bishnoi (53 minutes later)

Hello
Welcome to Health Care Magic

You have history of anxiety disorder for about 10 years. Currently you are having complaints of sore jaw and pain in left shoulder. You have undergone Electrocardiogram and blood investigations which came normal. Stress echo also came normal. There is no history of heart diseases. So over all problems of heart has been ruled out.

As you have mentioned that blood investigations came normal so any possibility of anaemia has been ruled out.

Now coming to anxiety disorders. These are not typical symptoms of anxiety. But somatic presentation of anxiety may present in this way. Recurrent shoulder pain and pain in jaw with every investigation came normal may be due to somatic symptoms. Due to unconscious anxiety some people don't show typical features of anxiety but may present as Somatic symptoms like in your case.

Management is also different.
Psychosocial techniques like Psychotherapies may help to reveal the source of anxiety and consequent improvement. Behavioral modification like Muscle relaxation techniques will help in relaxation.

Medicines like Benzodiazepines as Clonazepam, Etizolam can also be used in as need basis for control of symptoms. No other prolonged medicine therapy is usually needed. But in some people other medicines like SSRI as Fluoxetine, Sertaline or SNRI as Duloxetine help in early improvement.
I will advise you to visit a good Psychiatrist for evaluation of anxiety.

Hope I cleared your doubt, If you are having more queries you can ask again.

Thanks
Dr. Seikhoo Bishnoi MD

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Seikhoo Bishnoi (1 hour later)

Thank you for your reply. I am just so worried about my heart that it is all I can focus on. I have read that the echo stress test can sometimes only be 80% accurate, therefore I think I will be in that 20%. My BP is always good- actually low. Cholesterol is 162. I just dont know if I should ask for more testing? I try to tell myself it is anxiety and stress, but everytime I get a jaw pain or shoulder pain I think its my heart. Should I consider the echo stress to be reliable??

Answered by Dr. Seikhoo Bishnoi (10 minutes later)

Hello again

ECHO test can be considered reliable in your case because all of other investigations are normal and you are of young age, not in a risk age.

It is very uncommon for a young female of reproductive age group to have heart problem.

As per my opinion there is no need for repeat stress test because it will come normal. The symptoms you are having are because of anxiety and somatic phenomenon. Don't be stressed and try relaxation exercises at home.

Hope, I cleared your doubt. If you are satisfied with my answer kindly review. If you have more queries you can ask again.

Thanks.
Dr. Seikhoo Bishnoi

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T