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Major causes of musculoskeletal chest pain in adults

Christopher M Wise, MD
Section Editor
Don L Goldenberg, MD
Deputy Editor
Daniel J Sullivan, MD, MPH


Potentially life-threatening cardiac and pulmonary problems are usually the focus of the initial diagnostic evaluation for chest pain, although conditions affecting the musculoskeletal structures of the chest wall are among the most common causes of chest pain, particularly of discomfort that is often described as atypical or noncardiac chest pain (table 1). In addition, conditions affecting the structures in and around the thoracic cage that may cause chest pain also include diseases of the esophagus, upper abdomen, and head and neck. Early recognition of the musculoskeletal syndromes causing chest pain is an important element in the efficient and specific management of pain in patients with these conditions [1-6].

This topic will review the major causes of musculoskeletal chest pain. The evaluation of such patients and approaches to treatment are discussed separately. (See "Causes of nontraumatic chest pain in children and adolescents" and "Nontraumatic chest pain in children and adolescents: Approach and initial management".)

Other subjects reviewed in detail separately include the evaluation of chest pain in the emergency department; the general approach to the diagnosis and differential diagnosis of chest pain; and the causes, evaluation, and management of atraumatic chest pain in children and adolescents. (See "Outpatient evaluation of the adult with chest pain", section on 'Etiologies' and "Evaluation of the adult with chest pain in the emergency department" and "Clinical evaluation of musculoskeletal chest pain" and "Treatment of musculoskeletal chest pain".)


The proportion of patients with chest pain having a musculoskeletal source varies with the clinical setting; it affects up to a quarter of patients in the emergency setting and over a third of those in non-emergency ambulatory clinics. Chest wall tenderness is common but does not always reproduce the presenting symptoms, and such tenderness can occasionally be present even in patients with pain that is cardiac in origin.

Emergency department – In the emergency department, estimates of the frequency of a musculoskeletal origin for chest pain in adults range from approximately 10 to 50 percent, depending upon the setting and study design [7-13]. As examples:

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2017.
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