Chest Pain

Musculoskeletal Chest Pain

Musculoskeletal chest pain involves distress caused by the bony and cartilaginous anatomy of the anterior chest wall, the chest wall muscles, and the thoracic spine.

Additional reasons for discomfort or pain may include skin issues, neoplasms, chest wall contamination, metabolic conditions (low vitamin D levels), and rheumatic diseases.

Moreover, there are various causes of non-traumatic chest wall pain, including costochondritis, atypical chest pain, and cervicothoracic angina. A thorough history and physical examination are essential for an accurate diagnosis of musculoskeletal chest pain.

Musculoskeletal chest pain related to muscles

A muscle strain is one of the utmost usual reasons for chest pain in the musculoskeletal system. Muscle strains are often caused by overuse or trauma. It has also been reported that muscle pain may develop gradually due to stress or anxiety in the sufferer. Among all, specific muscle strains are generally included, such as; intercostal and pectoralis muscles.

1. Intercostal muscle strain

The intercostal muscles are utmostly afflicted in an estimated 50% of cases, followed by pectoralis muscles. There might be a pattern of excess exertion of untrained muscles in actions like painting a ceiling, cutting wood, or wheezing, and in sports with significant levels of upper body movement, like rowing.


The diagnosis must be medically constructed based on the record and physical tests. Local tenderness or pain may be experienced over the afflicted muscle groups, which boosts upon stretching or contracting the muscles with actions like deep inspiration and wheezing. Palpation of tenderness in the muscles is the most common finding.

2. Pectoralis muscle strain

The pectoralis muscle performs a vital role in the movement of the upper limbs and the chest wall. An indirect or direct blow can cause tears to the pectoralis muscle. Tears can be classified according to their cause or location.

An indirect bruise occurs when a muscle under great pressure is subjected to additional stress (eccentric muscle shrinking), resulting in high-grade injuries to athletes in sports like weight lifting and rugby.


Record and physical tests can help detect a problem, but imaging is usually required for a definitive detection, as medical assessment can be deluded by hemorrhaging or muscle bruise. Signs of tears involve sharp pain in the arm or shoulder with an audible pop, followed by inflammation and ecchymosis.

At the start of the assessment, radiographs may demonstrate soft tissue inflammation with no pectoralis shade. Ultrasound and magnetic resonance imaging are medical procedures that aid in making accurate decisions regarding optimal treatment.

Musculoskeletal chest pain related to thoracic spine

Thoracic disc herniation does not create a typical medical presentation and usually appears as nonspecific, acutely-onset midline discomfort in the thoracic region. It may present unilaterally or bilaterally.

The sensation may be irregular or persistent and can be aggravated by wheezing and straining. The spatial handling of pain differs according to the thoracic spinal segment and may be followed by sensory and motor disruption resulting from spinal cord compression. Degeneration is the most common reason, even though acute injury is primarily considered in young patients, particularly athletes.


MRI is the imaging technique to reveal thoracic disc herniation.

Musculoskeletal chest pain related to bones and cartilage:

The conditions of costochondritis and Tietze Syndrome are marked by discomfort and rigidness at the costochondral junctions.


People with chest pain may assume they have pneumonia, a bruised rib, or even a heart condition. Costochondritis is a very rare cause of chest pain. Costochondritis is a cartilage swelling that connects the upper ribs to the breastbone.

These locations are known as costochondral junctions. The situation causes chest pain, but it is generally not harmful and does not require treatment. However, certain unprescribed and prescribed medications can help treat the swollen cartilage.

You should be checked and tested for heart illness if you are experiencing chest pain in adulthood. Tietze syndrome is sometimes mistaken for costochondritis, but the two conditions are distinct. They differ in the following ways:

  • The symptoms of Tietze syndrome usually appear suddenly, with chest pain in your arms and shoulders and remaining for several weeks.
  • The Tietze Syndrome causes inflammation in the painful locations where ribs and breastbone join).


There is no specific test to diagnose costochondritis; your doctor can ask certain questions and perform various tests to determine the source of your chest pain.

  • Lab tests: Most lab tests aren’t necessary to diagnose costochondritis. Still, depending on your personal health history, your doctor may order some tests to determine whether your chest pain causes by another condition, such as pneumonia or coronary artery disease.
  • X-rays and ECGs: An X-ray may be necessary to ensure nothing abnormal with your lungs. In the case of costochondritis, your X-ray should be normal. They may also recommend an electrocardiogram (ECG) to ensure that heart problems do not cause chest pain.

Seek immediate emergency medical attention if you have difficulty breathing and unusual and debilitating chest pain.

Tietze syndrome

There is a rare swelling disorder called Tietze’s syndrome. A person experiences chest aching and cartilage inflammation on the upper ribs (costochondral junction), especially where the ribs connect to the breastbone (sternum). Symptoms of the pain may begin gradually or suddenly, and the pain may lay out to the arms and shoulders. In some cases, Tietze syndrome may resolve itself without treatment, or it can be a malignant condition. The cause of Tietze syndrome is unknown.


To diagnose Tietze syndrome, your doctor may conduct a clinical examination, a complete patient record, identification of characteristic signs, and exclusion of other reasons for chest discomfort. To rule out more severe causes of chest discomfort, various tests, such as electrocardiograms, x-rays, and biopsies, may be performed. It is possible to observe the thickening and enlargement of cartilage through magnetic resonance imaging (MRI).

Causes of Musculoskeletal chest pain

  • Chest injuries
  • Costochondritis
  • Tietze’s syndrome
  • Lower rib pain
  • Fibromyalgia
  • Rheumatic diseases include psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis.
  • Intercostal muscle strain and pulled chest muscle
  • A stress fracture in the ribs
  • Nerve entrapment

Symptoms of Musculoskeletal chest pain

Pain in the chest wall may be described as follows:

  • Aching
  • Stabbing
  • Sharp pain
  • Burning
  • Tearing
  • Pain becomes worse when you move your chest, twist your torso or raise your arms.
  • Increased pain when you sneeze, cough, or breathe deeply.

The following symptoms are also present:

  • Numbness
  • Tingling
  • Pain radiating from the back to the neck

Treatment of Musculoskeletal chest pain

Following treatment options can be used to treat these conditions;

  • Heat or ice
  • Anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve)
  • Muscle Relaxants
  • Stretching
  • Physical Exercise
  • Avoid activities that aggravate your pain.
  • A doctor may recommend corticosteroid injections if the inflammation is more severe or persistent.


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