Chest Wall (Musculoskeletal) Pain

The Many Causes of Chest (Musculoskeletal) Wall Pain

Chest pain is always an alarming symptom since it usually makes everyone—both you and your healthcare provider—think of heart disease. And because chest pain may indeed be a sign of angina or of some other cardiac (heart) problem, it is always a good idea to have it checked out. But heart disease is only one of the many types of conditions that can produce chest pain.

One of the more frequent causes of non-cardiac chest pain is chest wall pain, or musculoskeletal chest pain.

common causes of chest wall pain
​Illustration by Emily Roberts, Verywell

Diagnosis of Chest Wall Pain

Chest wall pain can be caused by problems affecting the muscles, bones, and/or nerves of the chest wall. Healthcare providers diagnose "chest wall pain" in at least 25% of patients who come to the emergency room for chest pain.

There are several causes of chest wall pain, and some types of chest wall pain may indicate a serious problem and may require specific treatment. In the great majority of instances, the underlying cause of chest wall pain is self-limited and is usually not serious.

Chest wall pain is a symptom, not a diagnosis. 

Here are the most common causes of chest wall pain.

Chest Trauma

Trauma to the chest wall can cause painful muscle sprains or strains, bruises, and/or rib fractures. The trauma may be s sudden event (such as being struck by a baseball or a car). Or it may be more subtle (such as lifting a heavy object) and you might not remember when it happened, especially if the onset of pain is delayed.

If you have chest wall trauma, your healthcare provider will ask you about activities that potentially might have caused it.

Costochondritis

Costochondritis, sometimes called costosternal syndrome or anterior chest wall syndrome, indicates pain and tenderness in the costochondral junction, which is the area along the sides of the breastbone where the ribs attach.

The pain of costochondritis usually can be reproduced by pressing on the affected area.

The causes of costochondritis are not well understood.

  • In children and young adults, this syndrome can occur with strain or weakening of the intercostal muscles (muscles between the ribs), following repetitive activities that place extra stress on those muscles, such as carrying a heavy book bag.
  • In some cases, costochondritis is associated with subtle dislocation of a rib. The dislocation may actually originate in the back, where the rib and the spine join. This relatively slight dislocation causes torsion of the rib along its length and produces pain along the breast bone (at the costochondral junction). The rib may "pop" in and out of its proper orientation (usually with some reproducible movement of the trunk or shoulder girdle), in which case the pain will come and go.

Costochondritis is usually a self-limited condition. Sometimes it is treated with localized heat or stretching exercises, but it is unclear whether such measures help. If the pain of costochondritis persists for more than a week or so, your healthcare provider may consider an evaluation looking for other chest wall conditions, and sometimes consulting with a chiropractor may also be useful.

Lower Rib Pain Syndrome

Lower rib pain syndrome (also called slipping rib syndrome) affects the lower ribs, and people who have this condition usually complain of pain in the lower part of the chest or in the abdomen.

In this syndrome, one of the lower ribs (eighth, ninth, or tenth rib) becomes loosened from its fibrous connection to the breastbone, usually following some type of trauma. The "moving" rib impinges on nearby nerves, producing the pain.

This condition is usually treated conservatively, with advice to avoid activities that reproduce the pain in an attempt to allow the ribs to heal. Surgery may be required to stabilize the slipping rib.

Precordial Catch

Precordial catch is a completely benign and very common condition, generally seen in children or young adults. With this condition, sudden, sharp chest pain occurs, usually on the left side of the chest, lasting for a few seconds to a few minutes.

It typically occurs at rest. During the episode, the pain increases with breathing. After a few seconds or a few minutes, the pain resolves completely. The cause of this condition is unknown, and it has no known medical significance.

Fibromyalgia

Fibromyalgia is a relatively common syndrome consisting of various, diffuse musculoskeletal pains. Pain over the chest is common with this condition.

Fibromyalgia often has many other symptoms in addition to pain, such as fatigue, sleep problems, and gastrointestinal symptoms.

Rheumatic Diseases

Chest wall pain associated with inflammation of the spine or rib joints can occur with several rheumatic conditions, in particular, rheumatoid arthritisankylosing spondylitis, and psoriatic arthritis.

Stress Fractures

Stress fractures of the ribs can affect athletes who engage in strenuous, repetitive motions involving the upper body, such as rowers or baseball pitchers. Stress fractures can also occur with osteoporosis or vitamin D deficiency.

Cancer

Advanced cancer invading the chest wall can produce significant pain. Breast cancer and lung cancer are the two most common kinds of cancer that grow into the chest wall. Primary cancer of the ribs is an extremely rare condition that can produce chest wall pain.

Sickle Cell Crisis

Chest wall pain can sometimes affect people during a sickle cell crisis. This may be due to small infarctions (blood clots) in the ribs. The rib pain usually resolves relatively quickly as the sickle cell crisis is brought under control.

Frequently Asked Questions

How do you treat a pulled chest muscle?

Follow the RICE method. Rest for at least two days; ice the area for 30 minutes three times a day; compress the muscle with an elastic bandage; and sit or lie upright to elevate the chest.

How long does costochondritis last?

Pain can last from weeks to months. Most people fully recover within 12 months, but about 33% of people with costochondritis continue to have muscle tenderness after a year, and some adolescents suffer from a chronic version of the disorder.

How do you manage fibromyalgia chest pain?

Over-the-counter painkillers can ease discomfort in the chest and other areas of the body, and your healthcare provider will focus on an overarching plan to treat fibromyalgia and your symptoms. This includes other prescription medications and lifestyle changes, such as exercising regularly. 

A Word From Verywell

Chest wall pain is very common and it is only rarely caused by a serious medical problem. Your healthcare provider will need to diagnose the cause of your chest wall pain in order to rule out a serious cause and recommend lasting treatment.

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Almansa C, Wang B, Achem SR. Noncardiac Chest Pain, and Fibromyalgia. Med Clin North Am 2010; 94:275.
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