Clinical evaluation of musculoskeletal chest pain
- Christopher M Wise, MD
Christopher M Wise, MD
- Professor of Internal Medicine
- Virginia Commonwealth University Health System
Chest pain is one of the more common symptoms requiring medical attention in the outpatient setting. Cardiac and pulmonary problems are usually the focus of the initial diagnostic evaluation. After these areas are excluded, other conditions affecting the structures in and around the thoracic cage enter into the differential diagnosis, including diseases of the esophagus, upper abdomen, head, neck, and chest wall .
This topic will review the clinical evaluation of chest pain of musculoskeletal origin (table 1). The major causes of chest pain are reviewed separately. (See "Major causes of musculoskeletal chest pain in adults" and "Evaluation of the adult with chest pain of esophageal origin" and "Angina pectoris: Chest pain caused by myocardial ischemia".)
Treatment of musculoskeletal chest pain is also presented separately. (See "Treatment of musculoskeletal chest pain".)
Demographic features, characteristics of the chest pain, and associated symptoms may favor the diagnosis of musculoskeletal chest pain or may suggest other causes of chest discomfort (table 2) . As an example, a history of repetitive or unaccustomed activity involving the upper trunk or arms is common in the patient with musculoskeletal pain .
Demographic features — The initial evaluation of chest pain should be undertaken in the context of the patient’s age, sex, family history, other coronary risk factors, and additional elements of his/her general health. In middle-aged or older patients or in those with other risk factors for coronary artery disease, a cardiac source should always be considered first, since patients with a known cardiac source of chest pain may also have chest wall tenderness that reproduces their pain [4-6]. (See "Angina pectoris: Chest pain caused by myocardial ischemia".)
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