Chest wall pain: Difference between revisions

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===Types===
===Types===
*'''Costochondritis (Tietze's syndrome)'''
*'''[[Costochondritis]]'''
**Inflammation of costal cartilages or sternal articulations
**Inflammation of costal cartilages or sternal articulations
**No localized swelling
**May be triggered by wearing backpack on one shoulder
**Crowing Rooster Maneuver
***Patients hands placed behind their head with neck extended. Posterior traction of both abducted shoulders reproduces pain.
*'''Tietze's syndrome'''
**Benign, painful, localized swelling of costosternal, sternoclavciular, or costochondral joints
**Associated with excessive coughing
*'''Xiphodynia'''
*'''Xiphodynia'''
**Inflammation of xiphoid process
**Inflammation of xiphoid process
*'''Precordial catch syndrome'''
*'''Precordial catch syndrome'''
**1-2 minute lancinating pain near the cardiac apex
**1-2 minute lancinating pain near the cardiac apex
**Associated with poor posture and inactivity
**May occur while bending over or slouching<ref>THE “PRECORDIAL CATCH,” A SYNDROME OF ANTERIOR CHEST PAIN. (1959). Annals of Internal Medicine, 51(3), 461. doi:10.7326/0003-4819-51-3-461 </ref>
*'''Sternalis syndrome'''
*'''Sternalis syndrome'''
**Tenderness directly over body of sternum or sternalis muscle
**Tenderness directly over body of sternum or sternalis muscle
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==Clinical Features==
==Clinical Features==
*Varying types of pain: sharp, dull, pleuritic
*Varying types of pain: sharp, dull, pleuritic
*Can be worsening by inspiration or coughing
*Can be worsened by inspiration or coughing
*Not typically associated with heart, erythema, or swelling
*Not typically associated with cardiac disease, erythema, or swelling (except Tietze's syndrome)
*Positive crowing roster maneuver or horizontal arm flexion
*Positive crowing roster maneuver or horizontal arm flexion
==Differential Diagnosis==
==Differential Diagnosis==
 
{{Chest Pain DDX}}


==Evaluation==
==Evaluation==
*Clinical diagnosis
*Clinical diagnosis
*EKG if ruling out ACS
*[[EKG]] if ruling out ACS
*consider CXR based on risk factors
*Consider [[CXR]] based on symptoms and risk factors


==Management<ref> Phillips, K and Schur, P. (2018). Treatment of musculoskeletal chest pain. In P.L. Romain (Ed.), UpToDate. Retrieved August 20, 2018 from https://www.uptodate.com/contents/treatment-of-musculoskeletal-chest-pain </ref>==
==Management<ref> Phillips, K and Schur, P. (2018). Treatment of musculoskeletal chest pain. In P.L. Romain (Ed.), UpToDate. Retrieved August 20, 2018 from https://www.uptodate.com/contents/treatment-of-musculoskeletal-chest-pain </ref>==
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**Hot or cold packs
**Hot or cold packs
*Pharmacologic
*Pharmacologic
**Topical capsaicin or diclofenac cream
**Topical [[capsaicin]] or [[diclofenac]] cream
**NSAIDs
**[[NSAIDs]]
**Acetaminophen
**[[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>
*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
*Discharge
*Follow up in 4-6 weeks
*Follow up in 4-6 weeks


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Wise, C. (2017). Major causes of musculoskeletal chest pain in adults. In P. L. Romain (Ed.), UpToDate. Retrieved August 20, 2018, from https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults
Wise, C. (2017). Major causes of musculoskeletal chest pain in adults. In P. L. Romain (Ed.), UpToDate. Retrieved August 20, 2018, from https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults
[[Category: Cardiology]]
[[Category: Misc/General]]
[[Category: Symptoms]]

Latest revision as of 18:51, 11 January 2022

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
    • Inflammation of costal cartilages or sternal articulations
    • No localized swelling
    • May be triggered by wearing backpack on one shoulder
    • Crowing Rooster Maneuver
      • Patients hands placed behind their head with neck extended. Posterior traction of both abducted shoulders reproduces pain.
  • Tietze's syndrome
    • Benign, painful, localized swelling of costosternal, sternoclavciular, or costochondral joints
    • Associated with excessive coughing
  • Xiphodynia
    • Inflammation of xiphoid process
  • Precordial catch syndrome
    • 1-2 minute lancinating pain near the cardiac apex
    • May occur while bending over or slouching[1]
  • 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 worsened by inspiration or coughing
  • Not typically associated with cardiac disease, erythema, or swelling (except Tietze's syndrome)
  • Positive crowing roster maneuver or horizontal arm flexion

Differential Diagnosis

Chest pain

Critical

Emergent

Nonemergent

Evaluation

  • Clinical diagnosis
  • EKG if ruling out ACS
  • Consider CXR based on symptoms and risk factors

Management[2]

  • Nonpharmacologic
    • Advise patient to avoid activity that lead to injury
    • Stretching
    • Hot or cold packs
  • Pharmacologic
  • Approximately 50% of patients will continue to have chest pain for 6-12 months with moderate limitation of activities [3]

Disposition

  • Discharge
  • Follow up in 4-6 weeks

References

  1. ↑ THE “PRECORDIAL CATCH,” A SYNDROME OF ANTERIOR CHEST PAIN. (1959). Annals of Internal Medicine, 51(3), 461. doi:10.7326/0003-4819-51-3-461
  2. ↑ Phillips, K and Schur, P. (2018). Treatment of musculoskeletal chest pain. In P.L. Romain (Ed.), UpToDate. Retrieved August 20, 2018 from https://www.uptodate.com/contents/treatment-of-musculoskeletal-chest-pain
  3. ↑ Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther 2017; 12:458.

Mahler S. Chapter 48: Chest Pain. In: Tintinalli J. Tintinalli's Emergency Medicine. A comprehensive study guide. 8th ed. 2016: 328.

Wise, C. (2017). Major causes of musculoskeletal chest pain in adults. In P. L. Romain (Ed.), UpToDate. Retrieved August 20, 2018, from https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults

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