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Chest Wall Pain

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Chest Wall Pain, Musculoskeletal Chest Pain, Chest Wall Tenderness

  • See Also
  1. Chest Pain
  2. Acute Chest Pain Approach
  3. Angina
  4. Angina Diagnosis
  5. Unstable Angina
  6. Chest Wall Pain
  7. Chest Wall Pain Prediction Rule
  8. Cardiac Risk Factors
  9. TIMI Risk Score
  10. Bosner Chest Pain Decision Rule
  11. Acute Coronary Syndrome
  12. Serum Cardiac Markers
  13. Electrocardiogram in Myocardial Infarction
  14. Echocardiogram in Myocardial Infarction
  • Evaluation
  1. See Chest Wall Pain Prediction Rule
  • Differential Diagnosis
  1. See Chest Pain
  2. Muscle Strain (overuse syndrome)
    1. Superior: Trapezius Insertion
    2. Mid: Pectoralis Muscle
    3. Inferior: Latisimus dorsi insertion
  3. Costochondritis
    1. Common, costochondral margin pain typically at several sites without swelling or induration
  4. Tietze Syndrome
    1. Rare, focal costochondral margin pain with localized swelling and inflammation
    2. Inflammation secondary to localized infection, neoplasm or Rheumatologic Condition
  5. Slipping Rib Syndrome
    1. Hypermobile, tender anterior portions of inferior costal cartilage
    2. "Hooking maneuver" reproduces pain (and in some cases a click)
      1. Hook fingers under lower ribs and pull anteriorly
  6. Fibromyalgia
    1. Chest Tender Points at second costochondral margin (in addition to 10 total of 18 points positive)
  7. Thoracic Herpes Zoster (Shingles) or Postherpetic Neuralgia
    1. Unilateral, Dermatomal Distribution of clustered vessicles on a red base
  8. Painful Xiphoid Syndrome
    1. Localized tenderness over the sternoxiphoid joint
  9. Arthritis
    1. May affect sternoclavicular joint or sternomanubrial joint
  10. Mastalgia (Breast Pain)
    1. See Mastalgia
  11. Pathologic Destruction of Costal Cartilage (by infection or cancer)
    1. Infection (Bacterial or fungal) or cancerous lesions may cause local destruction of costal cartilage
    2. Infections are higher risk in post-op state, as well as in intravenous drug use
  • Precautions
  1. See Chest Pain
  2. Heart disease can coexist with Chest Wall Pain
  • References
  1. How (2005) Eur J Intern Med 16(6): 432-6 [PubMed]
  2. Mott (2021) Am Fam Physician 104(1): 73-78 [PubMed]
  3. Proulx (2009) Am Fam Physician 80(6): 617-20 [PubMed]