Chest wall pain: Difference between revisions
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**No localized swelling | **No localized swelling | ||
*'''Tietze's syndrome''' | *'''Tietze's syndrome''' | ||
**Benign, painful, localized swelling of costosternal, | **Benign, painful, localized swelling of costosternal, sternoclavciular, or costochondral joints | ||
**Associated with excessive coughing | **Associated with excessive coughing | ||
*'''Xiphodynia''' | *'''Xiphodynia''' | ||
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==Clinical Features== | ==Clinical Features== | ||
*Varying types of pain: sharp, dull, pleuritic | *Varying types of pain: sharp, dull, pleuritic | ||
*Can be | *Can be worsened by inspiration or coughing | ||
*Not typically associated with | *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== | ||
*[[ACS]] | *[[ACS]] | ||
*[[Pneumothorax]] | *[[Pneumothorax]] | ||
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*Clinical diagnosis | *Clinical diagnosis | ||
*EKG if ruling out ACS | *EKG if ruling out ACS | ||
* | *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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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]] | |||
Revision as of 20:32, 7 September 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, 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
- 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 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
Evaluation
- Clinical diagnosis
- EKG if ruling out ACS
- Consider CXR based on symptoms and 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