Chest wall pain: Difference between revisions
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==Background== | ==Background== | ||
*Major cause of [[chest pain]] | |||
*Diagnosis of chest wall pain is given to a vast majority (10-50%) of all ED visits for chest pain | |||
===Types=== | |||
*'''Costochondritis (Tietze's syndrome)''' | |||
**Inflammation of costal cartilages or sternal articulations | |||
*'''Xiphodynia''' | |||
**Inflammation of xiphoid process | |||
*'''Precordial catch syndrome''' | |||
**1-2 minute lancinating pain near the cardiac apex | |||
**Associated with poor posture and inactivity | |||
*'''Sternalis syndrome''' | |||
**Tenderness directly over body of sternum or sternalis muscle | |||
*'''Lower rib pain syndromes (Rib tip syndrome, slipping rib)''' | |||
**Tenderness over costal margin | |||
**Can be associated with abdominal pain | |||
==Clinical Features== | ==Clinical Features== | ||
*Varying types of pain: sharp, dull, pleuritic | |||
*Can be worsening by inspiration or coughing | |||
*Not typically associated with heart, erythema, or swelling | |||
*Positive crowing roster maneuver or horizontal arm flexion | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | |||
*EKG if ruling out ACS | |||
*consider CXR based on risk factors | |||
==Management== | ==Management== | ||
*Nonpharmacologic | |||
**Advise patient to avoid activity that lead to injury | |||
**Stretching | |||
**Hot or cold packs | |||
*Pharmacologic | |||
**Topical capsaicin or diclofenac cream | |||
**NSAIDs | |||
**Acetaminophen | |||
*Approximately 50% of patients will continue to have chest pain for 6-12 months with moderate limitation of activities <ref>Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther 2017; 12:458. </ref> | |||
==Disposition== | ==Disposition== | ||
*Dischage | |||
*Follow up in 4-6 weeks | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 19:11, 20 August 2018
Background
- Major cause of chest pain
- Diagnosis of chest wall pain is given to a vast majority (10-50%) of all ED visits for chest pain
Types
- Costochondritis (Tietze's syndrome)
- Inflammation of costal cartilages or sternal articulations
- Xiphodynia
- Inflammation of xiphoid process
- Precordial catch syndrome
- 1-2 minute lancinating pain near the cardiac apex
- Associated with poor posture and inactivity
- Sternalis syndrome
- Tenderness directly over body of sternum or sternalis muscle
- Lower rib pain syndromes (Rib tip syndrome, slipping rib)
- Tenderness over costal margin
- Can be associated with abdominal pain
Clinical Features
- Varying types of pain: sharp, dull, pleuritic
- Can be worsening by inspiration or coughing
- Not typically associated with heart, erythema, or swelling
- Positive crowing roster maneuver or horizontal arm flexion
Differential Diagnosis
Evaluation
- Clinical diagnosis
- EKG if ruling out ACS
- consider CXR based on risk factors
Management
- Nonpharmacologic
- Advise patient to avoid activity that lead to injury
- Stretching
- Hot or cold packs
- Pharmacologic
- Topical capsaicin or diclofenac cream
- NSAIDs
- Acetaminophen
- Approximately 50% of patients will continue to have chest pain for 6-12 months with moderate limitation of activities [1]
Disposition
- Dischage
- Follow up in 4-6 weeks
References
- ↑ Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther 2017; 12:458.