Musculoskeletal chest wall pain syndromes
account for about 10% to 15% of cases in which adults are seen for chest pain
in the emergency room setting, and they account for about 15% to 20% of
patients who have had chest pain but whose coronary angiograms are negative.[34] The diagnosis of
musculoskeletal chest wall pain requires the finding of consistent areas of
tenderness that reproduce the patient's pain. In rare cases, chest pain may
result from Tietze syndrome--a benign, painful, nonsuppurative localized
swelling of the costosternal, sternoclavicular, or costochondral joints, most
often involving the area of the second and third ribs. In most cases, only one
area is involved. Young adults are more commonly affected.
More often, patients with musculoskeletal
chest wall syndromes have a more diffuse pain syndrome, termed costochondritis
or costosternal syndrome, the specific etiology of which is not well
understood. Areas of tenderness are not accompanied by heat, erythema, or
swelling; multiple areas of tenderness are found, usually in the upper
costochondral or costosternal junctions. A number of less common chest wall
syndromes have been described, each defined by the area of tenderness (e.g.,
xiphoidalgia, sternalis syndrome, and slipping rib syndrome). Musculoskeletal
chest wall syndromes are usually self-limited and respond to analgesics, local
heat, stretching exercises, and local glucocorticoid injection.
1. Sheon RP, Moskowitz
RW, Goldberg VM: Soft Tissue Rheumatic Pain: Recognition, Management,
Prevention, 3rd ed. Lea &Febiger, Philadelphia, 1996
2. Eck JC, Hodges
SD, Humphreys SC: Whiplash: a review of a commonly misunderstood injury. Am J
Med 110:651, 2001
3. Cassidy JD,
Carroll LJ, Cote P, et al: Effect of eliminating compensation for pain and
suffering on the outcome of insurance claims for whiplash injury. N Engl J Med
342:1179, 2000
4. Barnsley L,
Lord SM, Wallis BJ, et al: Lack of effect of intraarticular corticosteroids for
chronic pain in the cervical zygapophyseal joints. N Engl J Med 330:1047, 1994
5. Lord SM,
Barnsley L, Wallis BJ, et al: Percutaneous radio frequency neurotomy for
chronic cervical zygoapophyseal-joint pain. N Engl J Med 335:1721, 1996
6. Hoving JL,
Koes BW, de Vet HC, et al: Manual therapy, physical therapy, or continued care
by a general practitioner for patients with neck pain: a randomized, controlled
trial. Ann Intern Med 136:713, 2002
7. Swezey RL:
Conservative treatment of cervical radiculopathy. J Clin Rheumatol 5:65, 1999
8. Deyo RA,
Weinstein JN: Low back pain. N Engl J Med 344:363, 2001
9. Andersson GB:
Epidemiological features of chronic low-back pain. Lancet 354:581, 1999
10. Lee P, Helewa
A, Goldsmith CH, et al: Low back pain: prevalence and risk factors in an
industrial setting. J Rheumatol 28:346, 2001
11. Von Korff M,
Moore JC: Stepped care for back pain: activating approaches for primary care.
Ann Intern Med 134:911, 2001
12. Deyo RA, Diehl
AK, Rosenthal M: How many days of bed rest for acute low back pain? A
randomized clinical trial. N Engl J Med 315:1064, 1986
13. Malmivaara A,
Hakkinen U, Aro T, et al: The treatment of acute low back pain: bed rest,
exercises, or ordinary activity? N Engl J Med 332:351, 1995
14. Vroomen PC, de
Krom MC, Wilmink JT, et al: Lack of effectiveness of bed rest for sciatica. N
Engl J Med 340:418, 1999
15. Andersson GBJ,
Lucente T, Davis AM, et al: A comparison of osteopathic spinal manipulation
with standard care for patients with low back pain. N Engl J Med 341:1426, 1999
16. Cherkin DC,
Deyo RA, Battie M, et al: A comparison of physical therapy, chiropractic
manipulation, and provision of an educational booklet for the treatment of
patients with low back pain. N Engl J Med 339:1021, 1998
17. Moffett JK,
Torgerson D, Bell-Syer S, et al: Randomised controlled trial of exercise for
low back pain: clinical outcomes, costs, and preferences. BMJ 319:279, 1999
18. Daltroy LH,
Iverson JD, Larson MG, et al: A controlled trial of an educational program to
prevent low back injuries. N Engl J Med 337:322, 1997
19. Jensen MC,
Brant-Zawadzki MN, Obuchowski N, et al: Magnetic resonance imaging of the
lumbar spine in people without back pain. N Engl J Med 331:69, 1994
20. Deen HG:
Diagnosis and management of lumbar disk disease. Mayo Clin Proc 71:283, 1996
21. Salerno SM,
Browning R, Jackson JL: The effect of antidepressant treatment on chronic back
pain: a meta-analysis. Arch Intern Med 162:19, 2002
22. Carette S,
Marcoux S, Truchon R, et al: A controlled trial of corticosteroid injections
into facet joints for chronic low back pain. N Engl J Med 325:1002, 1991
23. Mannion AF,
Muntener M, Taimela S, et al: Comparison of three active therapies for chronic
low back pain: results of a randomized clinical trial with one-year follow-up.
Rheumatology (Oxford) 40:772, 2001
24. Cherkin DC,
Eisenberg D, Sherman KJ, et al: Randomized trial comparing traditional Chinese
medical acupuncture, therapeutic massage, and self-care education for chronic
low back pain. Arch Intern Med 161:1081, 2001
25. Arbit E,
Pannullo S: Lumbar stenosis: a clinical review. Clin Orthop 384:137, 2001
26. Saint-Louis
LA: Lumbar spinal stenosis assessment with computed tomography, magnetic
resonance imaging, and myelography. Clin Orthop 384:122, 2001
27. Simotas AC:
Nonoperative treatment for lumbar spinal stenosis. Clin Orthop 384:153, 2001
28. Amundsen T,
Weber H, Nordal HJ, et al: Lumbar spinal stenosis: conservative or surgical
management? A prospective 10-year study. Spine 25:1424, 2000
29. Steinfeld R,
Valente RM, Stuart MJ: A commonsense approach to shoulder problems. Mayo Clin
Proc 74:785, 1999
30. Green S,
Buchbinder R, Glazier R, et al: Systematic review of randomised controlled
trials of interventions for painful shoulder: selection criteria, outcome
assessment, and efficacy. BMJ 316:354, 1998
31. van der Windt DA,
Koes BW, Deville W, et al: Effectiveness of corticosteroid injections versus
physiotherapy for treatment of painful stiff shoulder in primary care:
randomised trial. BMJ 317:1292, 1998
32. Ebenbichler
GR, Erdogmus CB, Resch KL, et al: Ultrasound therapy for calcific tendinitis of
the shoulder. N Engl J Med 340:1533, 1999
33. Dahan TH,
Fortin L, Pelletier M, et al: Double blind randomized clinical trial examining
the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J
Rheumatol 27:1464, 2000
34. Wise CM: Chest
wall syndromes. Curr Opin Rheumatol 6:197, 1994
35. Hay EM,
Paterson SM, Lewis M, et al: Pragmatic randomised controlled trial of local
corticosteroid injection and naproxen for treatment of lateral epicondylitis of
elbow in primary care. BMF 319:964, 1999
36. Smidt N, van
der Windt DA, Assendelft WJ, et al: Corticosteroid injections, physiotherapy,
or a wait-and-see policy for lateral epicondylitis: a randomised controlled
trial. Lancet 359:657, 2002
37. Laupland KB,
Davies HD: Olecranon septic bursitis managed in an ambulatory setting. The
Calgary Home Parenteral Therapy Program Study Group. Clin Invest Med 24:171,
2001
38. Dawson D:
Entrapment neuropathies of the upper extremities. N Engl J Med 329:2013, 1993
39. Atroshi I,
Gummesson C, Johnsson R, et al: Prevalence of carpal tunnel syndrome in a
general population. JAMA 282:153, 1999
40. D'Arcy CA,
McGee S: The rational clinical examination: does this patient have carpal
tunnel syndrome? JAMA 283:3110, 2000
41. O'Gardaigh D,
Merry P: Corticosteroid injection for the treatment of carpal tunnel syndrome.
Ann Rheum Dis 59:918, 2000
42. Katz JN,
Losina E, Amick BC 3rd, et al: Predictors of outcomes of carpal tunnel release.
Arthritis Rheum 44:1184, 2001
43. Kapoor A,
Sibbitt W: Contractures in diabetes mellitus: the syndrome of limited joint
mobility. Semin Arthritis Rheum 18:168, 1989
44. Bird PA,
Oakley SP, Shnier R, et al: Prospective evaluation of magnetic resonance
imaging and physical examination findings in patients with greater trochanteric
pain syndrome. Arthritis Rheum 44:2138, 2001
45. Bernstein J:
Patellar disorders. J Clin Rheumatol 5:90, 1999
46. O'Keeffe ST:
Restless legs syndrome: a review. Arch Intern Med 156:243, 1996
47. Goldenberg DL:
Fibromyalgia syndrome a decade later: what have we learned? Arch Intern Med 159:777,
1999
48. Crofford LJ,
Clauw DJ: Fibromyalgia: where are we a decade after the American College of
Rheumatology classification criteria were developed? Arthritis Rheum 46:1136,
2002
49. O'Malley PG,
Balden E, Tomkins G, et al: Treatment of fibromyalgia with antidepressants: a
meta-analysis. J Gen Intern Med 15:659, 2000