What Is Chest Wall Pain?
Table of Contents
Symptoms of chest pain and discomfort are among the most common reasons provided for medical visits around the world. Further, it has been estimated that around 7.16 million visits are made annually to the emergency department due to chest pain. Between 1% and 3% of all visits to a primary care provider are actually attributed to this problem.
The symptoms of chest wall pain can be achy, sharp, or even pressure-like. In many cases, patients will report that their pain worsens upon:
- Moving their upper body
- Taking deep breaths
- Engaging in physical exertion
The most common form of this type of pain is costochondral pain, which is an inflammation of the cartilage connecting a rib to the breastbone.
What Is Costochondritis Pain?Interestingly, nearly 30% of patients with complaints of chest pain are ultimately diagnosed with costochondritis. Pain that occurs within the costosternal and costochondral regions of the anterior chest wall, in particular, is referred to as costochondritis. Costochondritis is also sometimes called:
- Costochondral pain
- Costosternal syndrome
- Costosternal chondrodynia
Patients of advancing age (i.e., 40 years of age and up) and who are of Hispanic origin are considered to be at an increased risk for pain associated with costochondritis.
The symptoms of costochondritis tend to be localized to the costal cartilage along the second through the fifth costochondral joints, particularly within the third and fourth ribs. Nonetheless, symptoms of chest wall pain may occur along any of the seven costochondral junctions. Moreover, these symptoms may also radiate out from the anterior chest wall to the neck or arm. It is not uncommon for patients to also report tenderness within the area.
What Is The Cause Of Chest Wall Pain?While reports of this type of pain tend to be incredibly common, the underlying cause for the condition is not completely understood.
While it is not uncommon for the precise source of chest wall pain to remain unknown, some possible causes of costochondritis include:
- Injury or trauma: Pain within the area of the chest wall may emerge as the result of a direct blow or injury to the area.
- Arthritis: Some evidence suggests that symptoms of costochondritis are associated with degenerative joint conditions, such as osteoarthritis or rheumatoid arthritis.
- Physical strain: Symptoms of costochondritis have been linked with periods of heavy lifting, extreme physical exertion, or even severe coughing, which likely places excessive strain to the underlying soft tissue of the chest.
- Infection: The various joints of the rib cage can become infected from fungi, bacteria, or a virus (e.g., syphilis or tuberculosis). These infections can cause irritation and inflammation of the area, which can lead to symptoms of pain and discomfort.
- Tumor: Symptoms of pain can emerge as the result of tumor. In fact, cancerous tumors may spread to the joints of the rib cage from other nearby areas of the body, such as the lung, thyroid, or breast.
Typically, pain associated with costochondritis emerges as the result of irritation and inflammation of the soft tissue that joins the ribs and the breastbone. Further, previous studies have indicated that this type of pain tends to occur more frequently among populations of women.
Diagnosing Chest Wall PainYour pain doctor may be able to diagnose costochondritis following a thorough physical examination; however, advanced imaging techniques should be employed to rule out any other potential sources for your symptoms.
Physical examination of chest wall pain will generally include gentle palpation of the:
- Posterior, anterior, and lateral thoracic regions
- The thoracic and lumbar spine
- Cervical spine
Any areas of tenderness are noted and better localized by palpation with a single digit. Your pain doctor will examine the movement of your rib cage through the use of deep breathing exercises. Movement of the upper extremities is generally assessed by moving the arm, while they also observe for pain, stiffness, and limits to range of motion.
How Long Does Chest Wall Pain Last?In most cases, symptoms of pain and discomfort within the chest wall that are associated with costochondritis resolve on their own. The actual course of the condition depends on a number of factors that can vary widely from patient to patient. A portion of patients will report that their pain and discomfort resolved within several weeks, while others may experience more persistent symptoms.
Nearly all cases of costochondritis are expected to resolve within one year. Acute cases may linger for a few days, but they may last up to several weeks. If your pain is due to a minor injury or trauma, the pain should resolve using at-home treatments discussed below. If you’ve suffered from chest wall pain for more than three months, it is considered a chronic form of pain. In this case, it’s important to talk to your doctor about ways to find relief. Chronic conditions generally fare worse the longer treatment is delayed.
You should talk to your doctor immediately, though, if you experience any of the following symptoms:
- Breathing issues
- Pain that is still severe or worsening after a few days
- Signs of infection, such as sweating, redness, or increased swelling
Signs of a heart attack that requires immediate medical attention include:
- Persistent chest pain
- Left arm pain
- Generalized chest pain that doesn’t have a localized source of pain
Women, however, typically experience heart attack symptoms differently. For example, women are more likely to experience secondary symptoms like back or jaw pain or nausea. Call 911 if you suffer from:
- Uncomfortable pressure, squeezing, or fullness in the center of your chest
- Pain or discomfort in one or both arms, your back, neck, jaw, or stomach
- Shortness of breath
- Sweat, nausea, or lightheadedness
Treatments For Chest Wall PainUnfortunately, there is very little research available on the effectiveness of potential treatments for chest wall pain. However, there are some at-home treatments you can use to reduce pain from an acute injury or trauma. For more severe cases of pain that aren’t related to heart attack, there are interventional treatments you can try.
At-home chest wall pain treatments
This type of pain generally resolves on its own. However, some at-home chest wall pain treatments can include:
- Taking over-the-counter oral analgesics
- Reducing some types of physical activity
- Using cough suppressants
- Applying a hot compress or heating pad
- Undergoing physical therapy
In most instances, over-the-counter oral analgesics are recommended as a first-line treatment. These medications may include acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).
Your physician may also recommend that you limit physical activities that tend to make the symptoms worse. For instance, you may be encouraged to reduce exercise intensity or temporarily decrease the degree of physical exertion you engage in at work. Further, using cough suppressants in order to reduce the severity of your cough may provide some relief from symptoms of chest wall pain.
Many patients may have success applying a hot compress or using a heating pad. This technique is particularly effective in instances of costochondritis that are the result of muscle overuse and strain.
Your doctor may also recommend a course of physical therapy. This particular treatment can be very beneficial for cases of musculoskeletal chest pain. They can also recommend at-home stretches for chest wall pain that you can do.
If you’re experiencing more persistent symptoms of pain and discomfort, you may wish to consider more aggressive forms of pain management. You should only attempt these more advanced treatments after other at-home treatments have failed. But, if this type of pain begins to severely impact your daily life, you should talk to your doctor about your options.
Chest wall pain treatments may include:
- Chest wall injections
- Chiropractic treatment
- Treatments focused on underlying conditions, such as arthritis, injury, or cancer
For cases of severe and chronic refractory pain, injections of analgesic medication may be effective in providing relief from your pain. This technique allows for a more targeted approach, such that the analgesic medication (generally lidocaine or corticosteroid) is delivered by injection directly into the affected area. The goal of these chest wall injections is to interfere with the transmission of pain signals from the peripheral nervous system to the spinal cord and brain. This technique is effective for managing more severe symptoms of chest wall pain, though it is very rarely necessary.
If you’re suffering from costochondritis that’s caused by an infection, your doctor will start you on a course of antibiotics.
If your pain is caused by a slight dislocation in the ribs, a pain specialist may recommend chiropractic care. In this case, a chiropractor will help manipulate the dislocation to move it back to its original position.
Finally, if arthritis or another pain condition is causing your pain, your pain doctor will work to find treatments that resolve those underlying conditions. In these cases, it can reduce or effectively relieve your symptoms.
ConclusionChest wall pain, which is also known as costochondritis, is a common condition. It is characterized by achy, sharp, or even pressure-like pain within the chest region. These symptoms may radiate out toward the shoulders and arms.
In most cases, the precise source of the pain is not known. But, in general, this type of pain is believed to be the result of irritation and inflammation of the underlying soft tissue of the chest. Symptoms of chest wall pain generally resolve on their own, though several treatment options are available for pain management. These can include physical therapy, injections, or chiropractic care.
If you’re suffering from chronic chest wall pain that’s lasted for three months or more, or pain that severely impacts your life, you need to talk to a pain specialist. They can help diagnose the cause of your pain and discuss treatment options that would work best for you. You can find a certified pain specialist in your area by clicking the button below.
- Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care 2013;40:863-87.
- McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician 2013;87:177-82.
- Brown AF, Cullen L, Than M. Future developments in chest pain diagnosis and management. Med Clin North Am 2010;94:375-400.
- Gokhale J, Selbst SM. Chest pain and chest wall deformity. Pediatr Clin North Am 2009;56:49-65.
- Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18:586-589.
- How J, Volz G, Doe S, Heycock C, Hamilton J, Kelly C. The causes of musculoskeletal chest pain in patients admitted to hospital with suspected myocardial infarction. Eur J Intern Med. 2005;16:432-436.
- Fam AG, Smythe HA. Musculoskeletal chest wall pain. Canadian Medical Association Journal. 1985;133(5):379-389. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346531/.
- Miller CD, Lindsell CJ, Khandelwal S, et al. Is the initial diagnostic impression of “noncardiac chest pain” adequate to exclude cardiac disease? Ann Emerg Med. 2004;44:565-574.
- Cayley WE Jr. Diagnosing the cause of chest pain. Am Fam Physician. 2005;72:2012-2021.