Chest Wall Pain

1. 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
2. Evaluation
   1. See Chest Wall Pain Prediction Rule
3. Differential Diagnosis
   1. See Chest Pain
   2. Muscle Strain
      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 inferior costal cartilage
   6. Fibromyalgia
      1. Chest Tender Points at second costochondral margin (in addition to 10 total of 18 points positive)
   7. Thoracic Herpes Zoster
      1. Unilateral, dermatomal distribution of 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
4. Precautions
   1. See Chest Pain
   2. Heart disease can coexist with Chest Wall Pain
5. References
   1. How (2005) Eur J Intern Med 16(6): 432-6
   2. Proulx (2009) Am Fam Physician 80(6): 617-20