II. Evaluation
III. Differential Diagnosis
- See Chest Pain
-
Muscle Strain (overuse syndrome)
- Superior: Trapezius Insertion
- Mid: Pectoralis Muscle
- Inferior: Latisimus dorsi insertion
-
Costochondritis
- Common, costochondral margin pain typically at several sites without swelling or induration
-
Tietze Syndrome
- Rare, focal costochondral margin pain with localized swelling and inflammation
- Inflammation secondary to localized infection, neoplasm or Rheumatologic Condition
- Slipping Rib Syndrome
- Hypermobile, tender anterior portions of inferior costal cartilage
- "Hooking maneuver" reproduces pain (and in some cases a click)
- Hook fingers under lower ribs and pull anteriorly
-
Fibromyalgia
- Chest Tender Points at second costochondral margin (in addition to 10 total of 18 points positive)
- Thoracic Herpes Zoster (Shingles) or Postherpetic Neuralgia
- Unilateral, Dermatomal Distribution of clustered vessicles on a red base
- Painful Xiphoid Syndrome
- Localized tenderness over the sternoxiphoid joint
-
Arthritis
- May affect sternoclavicular joint or sternomanubrial joint
-
Mastalgia (Breast Pain)
- See Mastalgia
- Pathologic Destruction of Costal Cartilage (by infection or cancer)
- Infection (Bacterial or fungal) or cancerous lesions may cause local destruction of costal cartilage
- Infections are higher risk in post-op state, as well as in intravenous drug use
IV. Precautions
- See Chest Pain
- Heart disease can coexist with Chest Wall Pain