Non-Cardiac Chest Wall Pain
Relief for Non Cardiac Chest wall pain can be difficult to come by. Quite often a full evaluation is done to rule out cardiac sources of chest pain but if none are found consideration of non cardiac causes can be lacking.
Non Cardiac Chest wall pain refers to chest pain secondary to musculoskeletal or inflammatory causes. The pain may be secondary to a muscle strain in the chest wall itself, or in the back. It may be secondary to sprained ligaments in the neck, mid back, shoulder or chest wall itself. It may be due to nerve entrapment, irritation or to non cardiac vascular sources (such as thoracic outlet syndrome).
Common symptoms and findings of chest wall pain include pain that is increased with motion of the chest or upper (thoracic) spine. The pain is often worse when breathing deeply, sneezing, or coughing. There may be a region of tenderness in the chest wall or in a muscle group. Chest wall pain SHOULD NOT be associated with shortness of breath, sweating, nausea, or fever.
Evaluation may include a chest x-ray if a rib fracture or pneumothorax is suspected. EKG (ECG) may be done on patients with a cardiac history or in those with significant risk factors for the development of cardiac disease (smoker, diabetic, obesity, high cholesterol, hypertension). Neuro-musculoskeletal sources of chest wall pain are evaluated with different tests including EMG/NCV, Musculoskeletal Ultrasound and Sympathetic Skin Response studies (Thermography).
Initially chest wall injuries and muscle strains are managed with heat, anti-inflammatory medications (such as ibuprofen), muscle relaxers, stretching and physical therapy. In more severe or chronic cases local injection or nerve block may be required. When spinal injuries are the source of chest wall pain they have to be addressed separately. Weight reduction can also decrease chest wall pain in obese patients.
At Piedmont Physical Medicine & Rehabilitation, PA we specialize in the diagnosis of complex, chronic pain, physical medicine & rehabilitation, and peripheral vascular medicine. As a result of expertise across these disciplines we enjoy the challenge associated with the diagnosis and treatment of non cardiac chest wall pain. We also believe that results are improved when the underlying root cause of the pain is treated instead of simply resorting to symptom management.