Chest wall pain

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

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

Disposition

• Dischage
• Follow up in 4-6 weeks