This section covers pain anywhere between shoulders to the bottom of ribs. It can arise from
- Inside the thoracic cavity (inside chest)
- From the chest wall including the thoracic spine
- Be referred from the neighbouring areas and structures such as abdomen, cervical spine.
Chest wall pain can originate from any of the chest wall structures including bones, joints, muscles, cartilage, ligaments, tendons, nerves, skin and soft tissue. It generally increases with arm movement and is accompanied by localised tenderness.
Some common conditions/situations leading to chest wall pain are
- Prolonged unaccustomed physical activity. This may cause muscle soreness which can persist
- Trauma/fall with fracture of ribs or vertebrae. In presence of osteoporosis even trivial trauma can lead to fractures. The event may be difficult to remember especially when the onset of pain is delayed
- The spine can be a source of posterior chest pain. Pain may arise from joints including those between the vertebrae (facet joints), between the ribs and vertebrae (costovertebral joints, costotransverse joints), discs, spinal ligaments, muscles (paravertebral muscles), and the nerves. The pain can radiate towards the side of the chest and as far as the front of the chest and abdomen
- Other joints such as the one between the collar bone and sternum or the ones between the ribs and sternum can also be a source of chest wall pain. Inflammation of the cartilage connecting the ribs to the sternum is known as chostrochondritis
- Infections such as Shingles commonly affect the thoracic area (Post Herpetic Neuralgia)
- Rheumatological disorders such as rheumatoid arthritis, ankylosing spondylitis
- Post-surgical pain arising after surgeries such as heart, lung, breast surgery
- Nerve injury or damage as a result of surgery, trauma, or otherwise.
- Cancer which has spread to the chest wall or bones
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