What Is Chest Wall Pain?
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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. Previous studies have indicated that chest wall pain tends to occur more frequently among populations of women.
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
- Engaging in physical exertion
The most common form of chest wall 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, or 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 chest wall 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 chest wall 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 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, 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, chest wall pain associated with costochondritis emerges as the result of irritation and inflammation of the soft tissue that joins the ribs and the breastbone.
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 the symptoms.
Physical examination of chest wall pain will generally include palpation using gentle pressure 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 observing 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 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. Acute cases may linger for a few days, but they may last up to several weeks. If it’s 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. Talk to your doctor about ways to find relief.
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. 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
Women are more likely to experience these secondary symptoms like back or jaw pain or nausea.
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 chest wall pain that aren’t related to heart attack, there are interventional treatments you can try.
At-home chest wall pain treatments
In most instances, over-the-counter oral analgesics are recommended as the first line of chest wall pain 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.
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. If chest wall pain begins to impact your daily life, you should also talk to your doctor about your options.
For cases of severe and chronic refractory chest wall 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.
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 pain doctor about appropriate treatments for their symptoms of chest wall pain.
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