Chest wall pain: Difference between revisions
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===Types=== | ===Types=== | ||
*'''Costochondritis | *'''Costochondritis''' | ||
**Inflammation of costal cartilages or sternal articulations | **Inflammation of costal cartilages or sternal articulations | ||
**No localized swelling | |||
*'''Tietze's syndrome''' | |||
**Benign, painful, localized swelling of costosternal, sternoclvaciular, or costochondral joints | |||
**Associated with excessive coughing | |||
*'''Xiphodynia''' | *'''Xiphodynia''' | ||
**Inflammation of xiphoid process | **Inflammation of xiphoid process | ||
| Line 20: | Line 24: | ||
*Varying types of pain: sharp, dull, pleuritic | *Varying types of pain: sharp, dull, pleuritic | ||
*Can be worsening by inspiration or coughing | *Can be worsening by inspiration or coughing | ||
*Not typically associated with heart, erythema, or swelling | *Not typically associated with heart, 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== | ||
*[[ACS]] | |||
*[[Pneumothorax]] | |||
*[[GERD]] | |||
*[[Pneumonia]] | |||
*[[Pulmonary embolus]] | |||
*[[Rib fracture]] | |||
*Arthritis | |||
*[[Herpes zoster]] | |||
==Evaluation== | ==Evaluation== | ||
Revision as of 19:29, 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
- Inflammation of costal cartilages or sternal articulations
- No localized swelling
- Tietze's syndrome
- Benign, painful, localized swelling of costosternal, sternoclvaciular, or costochondral joints
- Associated with excessive coughing
- 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 (except Tietze's syndrome)
- 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[1]
- 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 [2]
Disposition
- Dischage
- Follow up in 4-6 weeks
References
- ↑ 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
- ↑ 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