Chest Wall Pain can be pleuritic or non-pleuritic.
Pleuritic pain upon breathing and coughing, and also with at least one other movement of the torso (reaching, bending, twisting, etc.). The latter is a give-away for muscle involvement (vs. pulmonary) — no need for a CXR unless other suggestion of lung disease. There may not be tenderness to palpation, but if there is, the diagnosis is clinically clinched (as long as the tenderness isn’t extremely focal to a rib — see “pathologic fracture” above).If non-pleuritic chest pain, “Chest Wall” is Diagnosis of exclusion — only consider if:
- Coronary disease unlikely by risk factor analysis; OR
- Chronology & Duration not compatible with angina / infarction, AND
- Pain isn’t associated with exertion.
Suspect when non-pleuritic chest pain is associated with a specific movement of the torso or shoulder. Also suspect if there’s tenderness to palpation, especially if it reproduces the pain. Just be sure there’s no chance of a pathologic rib fracture. See postings Chest Pain – 2 (pleuritic) and Chest Pain – 3 (non-pleuritic).