Chest Wall Pain is also known as costosternal syndrome or costochondritis or costosternal chondrodynia. If chest wall pain presents along with swelling it is known as Tietze syndrome.
Chest wall pain is a condition in which cushion like cartilage connected with the rib of the breastbone i.e. sternum becomes inflamed resulting in sharp pain in the costosternal joint i.e. the place where breastbone and ribs get connected with the cushion like cartilage. Pain associated with costochondritis may imitate conditions like heart attack or other heart problems.
Most of the cases of chest wall pain fail to demonstrate the exact reason for the condition, hence the treatment often concentrates on relieving the pain so that the disease resolves on its own.
Epidemiology of Chest Wall Pain
Although chest wall pain is a self-limiting condition, the patients frequently experience persistent and recurrent symptoms of the disorder. Women are more prone to chest wall pain. Individuals more than 40 years of age are more likely to experience chest wall pain. About 69 percent women suffer with chest wall pain.
What Can Cause Chest Wall Pain?
The exact cause of chest wall pain is still not known, however, the suspected causes may include:
- Injury: A direct blow to the chest may cause chest wall pain.
- Physical Strain: Strenuous exercise and heavy lifting may also cause chest wall pain.
- Arthritis: In some cases, chest wall pain may also be caused due to the presence of other diseases like rheumatoid arthritis, ankylosing spondylitis and osteoarthritis.
- Joint Infection: Bacteria, fungi and viruses infecting the joints of the ribs also cause chest wall pain.
- Tumors: Cancerous and noncancerous tumors can cause chest wall pain. Cancer may spread to the joint from any other part of the body like the thyroid, lung and breast.
- Infection: Development of infection in the costosternal joint often causes pain in the chest wall.
Signs and Symptoms of Chest Wall Pain
- Pain and tenderness on left side of breastbone.
- Chest wall pain generally affects more than one rib.
- Pain worsens when taking deep breaths or coughing.
- Pain while taking deep breaths.
- Pain is also experienced while coughing.
- Difficulty while breathing.
Diagnosis Of Chest Wall Pain
Chest wall pain may imitate conditions like heart attack or other heart or gastrointestinal problems, hence a thorough subjective and physical examination is performed to diagnose chest wall pain. Tenderness or swelling in the breastbone areas may be seen on physical examination with different types of maneuvers.
Diagnostic tests that assist in ruling out other conditions causing pain in the chest wall may include:
- Chest x-ray.
What Are The Treatment Options For Chest Wall Pain?
Chest wall pain usually gets cured on its own. However in few cases chest wall pain may continue for many months or longer, therefore its treatment often concentrates on relieving the pain.
Medications for Chest Wall Pain
Treatment for chest wall pain starts with over-the-counter pain relievers. In case they do not work satisfactorily then following medications may be prescribed:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) For Pain In The Chest Wall: NSAIDs like naproxen and ibuprofen may be prescribed. However, NSAIDs have side effects which may result in damaging the stomach lining and kidneys.
- Narcotics For Pain In The Chest Wall: Medications containing codeine are prescribed for severe chest wall pain. These medicines may include oxycodone and hydrocodone. Narcotics have the potential to be addictive; hence they need to be used carefully.
- Antidepressants: Tricyclic antidepressants like amitriptyline often help in controlling chronic chest wall pain.
- Anti-Seizure Drugs: Anti-seizure drugs like gabapentin also help in controlling chronic chest wall pain.
Physical Therapy for Chest Wall Pain
- Stretching Exercises: Range of motion exercises may help in relieving chest wall pain.
- Nerve Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) unit is a device which sends a weak electrical current through adhesive patches present on the skin near the pain area. Transcutaneous electrical nerve stimulation interrupts signals of chest wall pain in order to avoid their transition to the brain.
Surgical Procedures for Chest Wall Pain
When conservative measures fail to relieve chest wall pain, injecting corticosteroids directly into the painful joint is suggested.