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Upper back pain on left rhomboid

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I am suffering from upper back pain (90% on rhomboid left) which i got during intense gym activity . i am also feeling pain in my tendons when i join my neck to my chest and due to this prolonged pain i am also feeling pain in my cervical portion . Got this injury 1 yr back and from then to now i have used everything like 3-4 months of physiotherapy , also visited to around 3 spine specialist and one rheumatologist and one neurologist but no one is able to solved it. Also did x -ray and MRI and nothing came out from them. Now i am following Dr avatar who is a pain specialist and he is giving me a tab called tryptomer and during its uses i found around 70-80 % relief in my pain and i am taking it since last 3 months. Please give me an advice what should i do now because it is taking too much time. Doctor analysed it as a breaking and weakening of tendons.Is taking tryptomer worthwhile ? THERE IS ALSO FREQUENT INJURY IN DIFFERENT PARTS OF MY BODY(MUSCLE PULL ) IF I DO ANY PHYSICAL ACTIVITY WHICH WAS NOT THERE BEFORE THIS PAIN.

Category: Rheumatologist

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Category: Internal Medicine Specialist
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Thanks for your query at

To help you best i would require 2 things -
1. The list of tests done from all the doctors
2. Information on whether someone has examined you for joint hypermobility syndrome.

I shall reply once i go through the test reports and clinical examination findings.

Look forward to your reply.

Dr Pandey

Patient replied :

sir i am uploading a pdf file containing various tests done on me and excluding these tests they also did MRI and x-ray and nothing came out from them they are 100% normal. Doctors analysed it as the breaking and weakening of tendons and ligaments . and i have 3 ques
1) should i continue the use of tryptomer ?(becuase it is causing constipation )
2)if this is the condition of tendons and ligaments breakup is there any advance treatment (kind of injection or oral steroids )available excluding surgery which can fast up the process of healing .
3)should i continue my strength training in this condition because i am feeling a bit better due to this .

Dear Sir,

Thanks for your reply.

I have gone through the reports, other than mild Vit D deficiency your reports are normal. based on your history and description my diagnosis is joint hyper-mobility syndrome with with Vit D deficiency and mild fibromyalgia responding to tryptomer.

I would request you to continue Tryptomer and get a rheumatologist to observe for Joint hypermobility syndrome.

Please increase fibre content in your diet.

Take your Vit D supplementation. I would suggest not to take any steroids.

Also i would recommend to get your HLA B 27 by PCR.

Hope this helps, please feel free to discuss further.


Patient replied :

thank you sir .i am taking multivitamins and mineral to full fill deficiencies related to vitamins and mineral .i am also taking a very healthy diet full of all required content .although i have some questions please answer them .
1)i want to know is there any test which will verify that i have fibromyalgia and Joint hypermobility syndrome
2) if i have fibromyalgia whom do i visit a neurologist or a rheumatologist ? because according to Wikipedia fibromyalgia is Central nervous system disease
3)how much time it will take to recover from these disease once they identified ?
4)i am doing cardio and strength training in order to strengthen my weak back ? Is it fine or i have to discontinue this activity ?
5)can you take me under your supervision and help me to fight with these disease ?
6)once the disease is gone is there any chance for it to come back ?
please include answer to all questions in your reply because all are important for me .


Thanks for the follow-up.

Fibromyalgia can be easily treated by a neurologist and a Rheumatologist. However, if you are having joint hypermobility associated fibromyalgia it will be best treated by a rheumatologist. To verify your Joint hypermobilty please consult a rheumatologist in person.

There is a test called functional MRI for fibromyalgia but it is not done in all the centers. It is best interpreted by research labs only, that too out of India.

For joint hypermobility, clinical examination has to be done.

Based on whether you have primary fibromyalgia or secondary fibromyalgia due to hypermobility snydrome the outcome can be determined.

Please let me know about you HLA B 27 status.

Fibromyalgia is quite treateble condition.

Hope I have answered all queries from the follow-up.


Patient replied :

sir when i contacted diagnosed labs they were asking which HLA B27 by PCR test i want ? there are many HLA B27 test. please elaborate this. one i found close to this is HLA B27 detection test , RT PCR (RT-real time) others are
HLA B27 blood

you didnt mention your answer to few question in your previous reply so i am again asking them
1))i am doing cardio and strength training in order to strengthen my weak back ? Is it fine or i have to discontinue this activity ?
2)how much time it will take to recover from these disease once they identified ?

and one more thing there is a constant pain at one point of my rhombidal left but according to the little knowledge i am having by googling that the pain of fibromyalia is on and off then what is the reason behind this constant pain (this is always on whenever i press that point i can feel that pain) please answer to all my question sir its a request .
thanks a lot for your efforts and the time you gave me for understanding the condition i have . once i get the actual name of test from your side i will get the test done and mail the report to you

Hello again,

HLA B 27 by PCR, is required before I CAN GIVE SPECIFIC ANSWERS.

Any exercise is as per the expertise of your physiotherapist. He will be able to guide what to do how to do.

I understand your anxiety but i would like you to get back with two answer to me before I can tell any time frame. Ask your physio or Rheumatologist for any signs of Joint hypermobility syndrome. And please get back with HLA B 27 by PCR report.


Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
Dr. Bimlesh Dhar Pandey and 4 other Medical Specialists are ready to help you

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