What Is Chest Wall Pain?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, while between 1% and 3% of visits to a primary care provider are attributable to this problem. Pain that occurs within the costosternal and costochondral regions of the anterior chest wall, in particular, is referred to as costochondritis. Interestingly, nearly 30% of patients with complaints of chest pain are ultimately diagnosed with costochondritis. Previous studies have indicated that chest wall pain tends to occur more frequently among populations of women. Further, patients of advancing age (i.e., 40 years of age and up) and who are of Hispanic origin are considered to be at an augmented risk for chest wall pain associated with costochondritis.
The symptoms of chest wall pain can be described as achy, sharp, or even pressure-like. In many cases, patients with chest wall pain will report that their pain worsens upon moving their upper body, taking deep breaths, or engaging in physical exertion. 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.
Causes Of Chest Wall PainWhile reports of chest wall pain tend to be incredibly common, the underlying cause for the condition is not completely understood. Your physician may be able to diagnose costochondritis following a thorough physical examination; however, advanced imaging techniques may be employed to rule out any other potential sources for the symptoms.
Physical examination of chest wall pain will generally include palpation using gentle pressure of the posterior, anterior, and lateral thoracic regions. Any areas of tenderness are noted and better localized by palpation with a single digit. The thoracic and lumbar spine, cervical spine, shoulders, and clavicle are also assessed by palpation during the physical examination of chest wall pain. Your physician 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 observing for pain, stiffness, and limits to range of motion.
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 has suggested 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, leading 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.
In general, chest wall pain associated with costochondritis likely emerges as the result of irritation and inflammation of the soft tissue that joins the ribs and the breastbone.
Treatments For Chest Wall PainThere is very little research available on the effectiveness of potential treatments for chest wall pain. In most instances, over-the-counter oral analgesics are recommended as the first line of treatment. These medications may include acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). Your physician may also recommend that you limit the 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 with chest wall pain may have success with 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. A course of physical therapy may also be recommended, as this particular treatment has shown to be beneficial in other instances of musculoskeletal chest pain.
In most cases, symptoms of pain and discomfort within the chest wall associated with costochondritis are expected to resolve on their own. The actual course of the condition depends on a number of factors and 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.
Patients experiencing more persistent symptoms of pain and discomfort may wish to consider more aggressive forms of pain management. This is typically considered when the patient begins to experience ongoing impairments in functioning as the result of the pain. For these cases of refractory chest wall pain, injections of analgesic medication may be effective in providing the patient with relief from 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 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.
ConclusionChest wall pain, which is also known as costochondritis, is a common condition and 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. In general, chest wall 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. Patients are encouraged to speak with their physician about appropriate treatments for their symptoms of chest wall pain.
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