Pain located where the shoulder meets the chest involves multiple complex structures, including the clavicle (collarbone), sternum (breastbone), and scapula (shoulder blade). This region contains an intricate network of joints, cartilage, muscles, and tendons. Discomfort in this specific spot is a frequent complaint that can be confusing to identify due to many possible origins. This article clarifies the most frequent causes of pain, ranging from joint trauma to inflammation and muscle strain.
Pain Related to the Main Shoulder Joints
Structural damage to the two primary joints connecting the shoulder to the torso can cause pain near the chest. The sternoclavicular (SC) joint is located where the clavicle meets the sternum, while the acromioclavicular (AC) joint connects the clavicle to the acromion of the shoulder blade. Injuries to these joints often result from significant trauma or chronic wear.
The AC joint is frequently injured by a direct blow to the shoulder. This impact can cause a separation, involving spraining or tearing the supporting ligaments. These injuries are typically graded by severity, with higher grades resulting in a visible bump or complete dislocation. Osteoarthritis, a degenerative wear-and-tear condition, is also common in the AC joint, particularly among older individuals or those who engage in heavy physical activities.
The SC joint requires a high-force event for injury, such as a motor vehicle accident or contact sport collision. Injuries range from a mild sprain to a full dislocation, classified as either anterior (forward) or posterior (backward). A posterior dislocation is serious because the displaced clavicle end can press upon structures like the trachea or major blood vessels behind the sternum. The SC joint can also develop osteoarthritis over time, leading to a dull, chronic ache and stiffness.
Understanding Chest Wall Cartilage Inflammation
A common, non-traumatic source of pain involves the inflammation of the cartilage connecting the ribs to the sternum, known as costochondritis. This condition causes tenderness and sharp pain that often worsens with deep breathing, coughing, or specific movements of the upper body. Because the pain is intense and localized near the sternum, it is frequently mistaken for a cardiac event, causing significant anxiety for the patient.
Costochondritis typically affects multiple costochondral joints, usually the second through fifth ribs, and does not involve visible swelling. The causes are often linked to preceding upper respiratory infections, bouts of heavy coughing, or unaccustomed physical strain. The condition is slightly more prevalent in women and generally affects individuals over 40.
A related but distinct condition is Tietze’s syndrome, differentiated by localized, palpable swelling over the affected joint. Tietze’s syndrome is rarer than costochondritis, usually involves only one joint, and most frequently affects the second or third rib. Both conditions are considered musculoskeletal causes of chest pain and are usually self-limiting.
Muscle and Soft Tissue Causes
Pain at the shoulder-chest junction can also originate from the surrounding musculature and their tendons. The pectoralis major muscle originates partly from the clavicle and sternum. A strain or tear in the pectoralis major, especially the clavicular head, is a common cause of sudden pain across the chest or near the front of the armpit.
These muscle injuries often occur during forceful eccentric contractions, such as during heavy lifting or contact sports. The pain is usually acute and may be accompanied by bruising or a temporary loss of strength when attempting to push the arm forward or across the body. The long head of the biceps tendon, which runs through the front of the shoulder, is another potential source of pain.
Inflammation of the biceps tendon, known as bicipital tendinitis, causes an aching pain localized to the front of the shoulder, which may be perceived as chest pain. Similarly, chronic issues like rotator cuff tendinopathy or subacromial impingement can produce referred pain. Although the rotator cuff is located more laterally, its irritation often results in a dull ache that radiates to the front of the shoulder and upper arm area.
Determining the Cause and Planning Recovery
Diagnosing the precise cause of pain relies on a thorough medical history and physical examination. A provider will ask about the onset of pain (sudden or gradual) and what activities make the pain better or worse. The physical exam includes palpation to identify specific points of tenderness, such as over the sternum for costochondritis or over a joint for a separation.
Imaging is frequently used to confirm a diagnosis and rule out more serious issues. X-rays can identify fractures, dislocations, and bone spurs associated with arthritis in the AC or SC joints. Magnetic resonance imaging (MRI) or ultrasound provides detailed views of soft tissues, helping to diagnose tendon tears, muscle strains, or significant ligament damage.
Recovery for most musculoskeletal causes involves a conservative approach, including activity modification and rest. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and reduce inflammation. Physical therapy often focuses on restoring range of motion and strengthening the shoulder and chest muscles. In rare cases of severe joint dislocation or tendon rupture, surgical intervention may be necessary. Seek immediate medical attention if chest pain is severe, accompanied by difficulty breathing, dizziness, or spreading to the jaw or left arm, as these symptoms can indicate a life-threatening cardiac issue.