Chest Wall Pain

Aka: Chest Wall Pain, Musculoskeletal Chest Pain, Chest Wall Tenderness

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II. Evaluation

  1. See Chest Wall Pain Prediction Rule

III. 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 Vesicles 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

IV. Precautions

  1. See Chest Pain
  2. Heart disease can coexist with Chest Wall Pain

V. 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]

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