Treatment of musculoskeletal chest pain
- Kristine Phillips, MD, PhD
Kristine Phillips, MD, PhD
- Associate Professor
- Department of Medicine / Rheumatology
- Vanderbilt University Medical Center
- Peter H Schur, MD
Peter H Schur, MD
- Editor-in-Chief — Rheumatology
- Section Editor — Basic Science
- Professor of Medicine
- Harvard Medical School
- Section Editor
- Don L Goldenberg, MD
Don L Goldenberg, MD
- Section Editor — Pain Disorders in Rheumatology
- Emeritus Professor of Medicine, Tufts University School of Medicine
- Affiliate Assistant, Rheumatology Division, Oregon Health Science University
- Affiliate Instructor, School of Nursing Oregon Health Sciences University
There are many causes of chest pain that can be referred to as musculoskeletal. They can be separated into isolated musculoskeletal chest pain syndromes (table 1) and systemic disorders, the latter associated with either rheumatic or nonrheumatic diseases (table 2). The major causes of musculoskeletal chest pain are presented separately. (See "Major causes of musculoskeletal chest pain in adults".)
Musculoskeletal chest pain must be differentiated from chest pain due to potentially life-threatening disorders such as myocardial ischemia or infarction, pulmonary embolism, aortic dissection, or pneumothorax. The diagnostic approach to a patient with chest pain is presented separately. (See "Outpatient evaluation of the adult with chest pain".)
Therapeutic interventions for musculoskeletal disorders affecting the chest are generally similar to those for musculoskeletal pain elsewhere in the body. However, in the case of chest pain, a common patient concern, stated or unstated, is that the pain is due to heart disease, and this concern must be addressed as well. In this regard, the physical examination itself, particularly the examiner's ability to reproduce or exacerbate the chest pain by palpation or with various maneuvers, helps the patient understand the noncardiac nature of the problem. (See "Clinical evaluation of musculoskeletal chest pain".)
CAUSES OF MUSCULOSKELETAL CHEST PAIN
As mentioned in the introduction, there are many local and systemic diseases and disorders that cause musculoskeletal chest pain (table 1 and table 2). These causes are discussed in more detail elsewhere (see "Major causes of musculoskeletal chest pain in adults"). A brief summary of some selected causes follows:
●Costochondritis and Tietze's syndrome are both associated with tenderness of one or more of the costochondral joints. Although there is some controversy over whether these two disorders are truly distinct, in this discussion the term Tietze's syndrome is used for the combination of pain, tenderness and swelling, while costochondritis is used when swelling is absent.
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- CAUSES OF MUSCULOSKELETAL CHEST PAIN
- THERAPEUTIC INTERVENTIONS
- Patient education
- Physical measures
- Topical agents
- Nonopioid analgesics
- Nonsteroidal antiinflammatory drugs
- Muscle relaxants
- Local glucocorticoid injections
- - Sternoclavicular joint injection
- - Manubriosternal joint
- - Costochondral junctions
- Intercostal nerve block
- Disease modifying antirheumatic drugs
- Psychiatric evaluation and treatment
- TREATMENT OF SELECTED CONDITIONS
- Isolated musculoskeletal chest pain syndromes
- Sternoclavicular hyperostosis (SAPHO syndrome)
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Nonpharmacologic interventions
- Pharmacologic interventions
- - Acute pain
- - Chronic pain