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 doctor—think of heart disease. And because chest pain may indeed be a sign of angina or of some other 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 is caused by problems affecting the muscles, bones and/or nerves of the chest wall. Doctors diagnose "chest wall pain" in at least 25% of patients who come to the emergency room for chest pain.

Unfortunately, in many cases, that’s as far as the doctor takes the diagnosis. This is because ER doctors usually are focused on making sure it’s not cardiac pain. So once they have ruled out a serious problem, they often consider their job to be done.

But if you are the person having this “chest wall pain"—as thankful as you may be that you don’t have a heart problem—you still have pain. You’re interested in an actual diagnosis since that might help you to understand what you can do about the pain.

There are several causes of chest wall pain, and fortunately, in the great majority of instances, the underlying cause of chest wall pain is benign and most often is self-limited. However, some types of chest wall pain may indicate a serious problem and may require specific treatment.

Chest wall pain is a category, not a diagnosis. If you are told you have chest wall pain, you need to press your doctor to make a specific diagnosis—"What is causing my chest wall pain?" 

Fortunately, if the doctor focuses on making a specific diagnosis for a few minutes, it is usually pretty straightforward to home in on the underlying cause. Here are the most common causes of chest wall pain.

Chest Trauma

Trauma to the chest wall can cause muscle sprains or strains, bruises, or fractures of the ribs. The trauma may be due to some dramatic event (such as being struck by a baseball or a car).

Or, it may be due to some more subtle trauma (such as lifting a heavy object) that may be more difficult for the victim to recall clearly, especially if the onset of pain is delayed. As a result, when evaluating chest wall pain your doctor should ask you about activities that potentially might have caused chest wall trauma.


Costochondritis, sometimes called costosternal syndrome or anterior chest wall syndrome, merely 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 is generally localized to one particular spot, most typically on the left side of the breastbone. Whether left-sided costochondritis is actually more common, or whether people with left-sided chest pain are simply more likely to see a doctor because they're worried about a heart problem, is unknown.

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

The causes of costochondritis are very poorly understood. While the suffix "-itis" is generally used in medicine to indicate inflammation, there is actually no evidence of actual inflammation with costochondritis. That is, there is no swelling, redness, or heat in the painful area.

In children and young adults, this syndrome appears sometimes to be related to 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 seems to be related to a subtle dislocation of a rib. While chiropractors are well aware of rib dislocation as a cause of costochondritis, physicians have seldom heard of it.

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 along the breast bone (at the costochondral junction) this torsion produces pain

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. Chiropractors are generally adept at manipulating a dislocated rib back into its normal position and relieving the pain.

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, an evaluation looking for other chest wall conditions may be a good idea, and 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, but 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, in which 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, and 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 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 disorders, and gastrointestinal symptoms, which cause many physicians to characterize this condition as one of the dysautonomias.

Rheumatic Diseases

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

While it is uncommon for chest pain to be the only symptom associated with any of these conditions, unexplained chest wall pain, especially if an evaluation suggests it is related to arthritis or any other type of inflammatory disorder, should lead a physician to at least consider a rheumatic disease as a possible cause.

Stress Fractures

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


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

Sickle Cell Crisis

It is now believed that the chest wall pain sometimes seen in people with sickle cell crisis may be due to small infarctions 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, just like you would for other muscle strains. 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 anywhere 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, but your doctor 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 in people seen by doctors for chest pain, and is only rarely caused by a serious medical problem. In the large majority of cases it is relatively easy for an attentive physician to diagnose the cause of chest wall pain, and to recommend appropriate treatment.

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Article Sources
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Additional Reading
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