Chest wall pain describes discomfort originating from the structures forming the chest wall itself, rather than from internal organs like the heart or lungs. This includes the ribs, muscles, cartilage, nerves, and connective tissues. While often not indicative of a serious underlying condition, understanding its various causes is important.
Musculoskeletal Origins of Chest Wall Pain
Musculoskeletal issues are a common source of chest wall discomfort. Injuries and inflammatory conditions frequently contribute to this type of pain.
Costochondritis and Tietze syndrome involve inflammation of the cartilage that connects the ribs to the breastbone. Costochondritis typically causes localized tenderness and sharp pain, which can intensify with movement, deep breathing, or pressure on the affected area. It often affects multiple areas, commonly the second to fifth ribs, without visible swelling. Tietze syndrome is a less common form, characterized by similar pain, but it includes noticeable swelling over the affected cartilage, usually at the second or third rib. This swelling can feel warm and may persist even after the pain subsides.
Muscle strains in the intercostal or other chest wall muscles can result from various activities. Overuse, direct injury, or persistent, forceful coughing can lead to these strains. The pain is often described as soreness, tenderness, or a dull ache. This discomfort typically worsens with movements of the chest or upper spine, deep breathing, sneezing, or coughing.
Direct trauma to the chest can lead to rib fractures. Falls, impacts, or even severe coughing can cause these injuries. Symptoms include sharp pain, particularly with breathing, movement, or direct pressure on the injured area. Swelling or tenderness around the affected ribs may also be present. Most bruised or broken ribs heal naturally within two to six weeks.
Slipping rib syndrome is a less common condition involving hypermobility of the lower ribs. This occurs when the cartilage connecting these ribs becomes weakened or displaced. It causes sharp, intermittent pain, often accompanied by a clicking or popping sensation. The pain frequently worsens with specific movements such as twisting, bending, deep breathing, or coughing or sneezing.
Nerve-Related Causes
Chest wall pain can also stem from issues directly affecting nerves in the region. These causes involve irritation or damage to the nerve pathways themselves.
Intercostal neuralgia results from irritation or compression of the intercostal nerves. This nerve pain can manifest as sharp, stabbing, burning, or aching sensations in the ribs, chest, or abdomen. The pain may radiate and can be triggered or worsened by light activities like breathing, sneezing, or laughing. Causes can include chest trauma, surgical incisions, or nerve entrapment.
Shingles, also known as herpes zoster, is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. This reactivation leads to severe, burning, or tingling pain along specific nerve pathways, typically on one side of the chest wall. The pain often precedes the appearance of a characteristic rash, which consists of fluid-filled blisters that form a stripe or band. Even after the rash clears, a persistent pain condition called postherpetic neuralgia can develop in some individuals.
When to Seek Medical Attention
While many causes of chest wall pain are not serious, certain symptoms warrant prompt medical evaluation to rule out more significant conditions. Recognizing these warning signs allows for timely intervention.
Seek immediate medical attention if chest pain is accompanied by shortness of breath, dizziness, excessive sweating, or nausea. Pain that radiates to the arm, jaw, back, or stomach should also prompt urgent evaluation. A sudden, crushing, or squeezing sensation in the chest is a concerning symptom.
Pain that worsens with physical exertion or a personal or family history of heart disease are also important. Chest pain that occurs after significant trauma, or is accompanied by fever, chills, or a persistent cough, also requires medical assessment. Any new, severe, or unexplained chest pain should be evaluated by a healthcare professional for an accurate diagnosis and appropriate treatment.