Musculoskeletal Chest Pain

What is musculoskeletal chest pain?

Musculoskeletal chest pain is pain in your chest wall, the framework of muscles and bones that encloses your heart and lungs. Muscles, bones and connective tissues make up your musculoskeletal system.

Musculoskeletal chest pain might involve:

• Bones, joints or cartilage in your chest wall.
• Chest muscles, tendons or ligaments.
• Your thoracic spine (which runs behind your chest wall).

It can be hard to tell exactly where chest pain is coming from when you’re having it. But musculoskeletal pain in your chest has different qualities from typical chest pain, which might be related to your heart.

What does musculoskeletal chest pain feel like?

Musculoskeletal conditions and cardiac (heart-related) conditions are both common causes of chest pain that bring people to the hospital. Nevertheless, cardiac chest pain is considered “typical” chest pain.

Typical chest pain:

• Feels like pressure, squeezing or clenching.
• May spread from your chest to your neck and jaw or down your arms.
• May include tingling or numbing sensations.
• May be accompanied by sweating, nausea or shortness of breath.
• Feels worse with exercise and better when you rest.
• Feels better when you take nitroglycerin.

Typical chest pain isn’t always angina, a symptom of heart disease. But you should always see a healthcare provider to be sure. Typical chest pain that isn’t angina is called noncardiac chest pain.

Chest pain that doesn’t resemble angina is called atypical chest pain. Musculoskeletal chest pain is usually “atypical” in this sense. It might have only one or none of the characteristics listed above.

Musculoskeletal chest pain is more likely to:

• Be constant rather than sudden or coming and going.
• Be located in a particular spot, rather than radiating elsewhere.
• Be accompanied by swelling, tenderness or bruising.
• Feel worse when you apply pressure to it.
• Feel worse when you move your chest in certain ways.
• Feel worse when you cough, sneeze or breathe deeply.

These differences can provide clues to what’s causing your chest pain. But when you’re having chest pain, it’s best to act quickly and see a healthcare provider rather than trying to sort it out on your own.

How do I know for sure if my chest pain is musculoskeletal?

You might suspect you have musculoskeletal chest pain if your pain fits the profile, or if you think you might’ve been injured recently. But there’s no way to be sure without seeing a healthcare provider.

When in doubt, it’s always safer to get a diagnosis. It’s possible to have musculoskeletal chest pain and cardiac chest pain at the same time. It’s also possible you have a condition you don’t know about.

What is a musculoskeletal chest pain test?

A healthcare provider will physically examine you to narrow down the source of your musculoskeletal pain. They’ll test your range of motion and feel for tenderness at specific points along your chest wall.

What causes musculoskeletal chest pain?

Musculoskeletal chest pain has many possible causes. Some of the most common causes are injuries, like muscle strains and rib fractures. Injury may be a sudden event or may happen gradually over time.

Besides injuries, arthritis and other rheumatic conditions can cause inflammation and pain in your chest wall. Conditions that cause chest wall pain without apparent injury are called chest wall pain syndromes.

Major causes of musculoskeletal chest pain include:

• Muscle strains. A muscle strain or pulled muscle is a tear in your muscle from overstretching it. Sports, weightlifting and manual labor are common ways to pull a chest muscle. You can also strain one gradually by using it too often without resting. This is called a repetitive strain injury. 
• Rib fractures. Your ribs are the main bones that frame your chest wall and the easiest ones to fracture. A traumatic injury or accident, like a fall or a car crash, may cause a minor or major rib fracture. Repetitive stress from frequent activity or exercise may cause a stress fracture.
• Slipping rib syndrome. This condition affects the joints between your lower ribs, which are technically ligaments with cartilage tips. The ligaments get worn or stretched, and the cartilage tips slip partially out of place. It may be related to a previous injury or repetitive stress.
• Costochondritis. Costochondritis is inflammation of the cartilage that joins your ribs to your sternum — known as your costochondral joints. Your sternum (breastbone) runs down the front of your chest. Costochondritis is also called anterior chest wall syndrome (anterior means front).
• Rheumatoid arthritis: This autoimmune disease causes chronic inflammation in the cartilage that cushions your joints. Most people experience generalized joint pain and fatigue that comes and goes. Rheumatoid arthritis can affect the sternoclavicular joint in up to 20% of people who have it.
• Ankylosing spondylitis. This specific type of arthritis affects the joints in your spine. While it typically begins in your lower back, many people with this condition also experience inflammation in their thoracic spines and the joints in their rib cages, causing pain throughout their chest walls.
• Myofascial pain syndrome. This condition causes chronic pain in your muscles and fascia, usually in one specific area (like your chest wall). The pain originates from a single trigger point within one of the muscles, with a bump that your healthcare provider can find on an exam.
• Fibromyalgia. Fibromyalgia is another chronic condition that causes musculoskeletal pain and fatigue throughout your body. It usually flares up in episodes that come and go. Subtle changes in your body — like stress, hormone fluctuations and nutritional changes — can trigger a flare-up.

Less common causes include:

• Thoracic pain. Conditions affecting your thoracic spine may cause referred pain that you feel in your chest, sometimes even in the front. The most likely causes are a herniated disk or a stress injury to one of your costovertebral joints, which connect your thoracic vertebrae to your ribs.
• Psoriatic arthritis. This type of arthritis affects a percentage of people with psoriasis. Some people with psoriatic arthritis have the type that affects the joints in their spines. These may include thoracic joints and those in the back (posterior) of your chest wall.
• Tietze syndrome. Tietze syndrome involves inflammation of your costochondral joints, like costochondritis. But Tietze syndrome, which is less common, tends to affect your upper ribs, while costochondritis affects the lower ribs. Tietze syndrome also causes visible swelling.
• Precordial catch syndrome. This mysterious but ultimately harmless condition causes a brief, sharp left-sided chest pain. The “catch” occurs in your precordium, the part of your chest wall that covers your heart, but it’s not related to your heart. It might be related to slouching.
• Sternalis syndrome. This condition involves abnormal muscles called sternalis muscles that grow from your major chest muscles and cover your sternum. They cause pain when they become hyperactive and spasm. If you press on your sternum, the pain radiates to each side.
• Xiphoid process pain. Xiphoid syndrome (xiphoidalgia or xiphodynia) is a rare condition that causes pain in your xiphoid process, which is the tip of your sternum. The pain may radiate to your chest or your abdomen, or both. Infections and injuries can irritate your xiphoid process.
• Pleurodynia. Pleurodynia (Bornholm disease) is inflammation of your chest muscles due to a viral infection. It can cause episodes of sharp or stabbing muscle spasms, followed by a lingering dull ache that worsens when you take a deep breath. Fever and sweating are also common.
• Tumors. A malignant neoplasm (cancerous tumor) can spread from your lungs or breasts into your chest wall, causing musculoskeletal pain. Tumors originating in your chest wall are rare. But tumors that originate elsewhere may not cause any symptoms until they spread (metastasize).

Can anxiety or depression cause musculoskeletal chest pain?

Anxiety and depression can cause noncardiac chest pain. This type of pain doesn’t necessarily involve your musculoskeletal system, though. It might be psychosomatic, having no apparent physical cause.

But anxiety and depression can make your chest heave if, for example, you’re hyperventilating or sobbing heavily. This can make your chest sore, and if it’s frequent or severe, may cause a stress injury.

How do you fix musculoskeletal chest pain?

Treatment for musculoskeletal chest pain can vary, depending on the cause. Many of the common causes are temporary conditions that will heal with time and rest. Others are lifelong conditions.

Musculoskeletal pain often responds to hot or cold therapy and over-the-counter (OTC) pain relievers, like NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen. You can also try topical pain relief products, like patches and creams.

If your pain is severe or doesn’t improve, your healthcare provider might make other suggestions. If you have a chronic condition, like arthritis or myalgia, you might need to see a specialist (rheumatologist).

Regardless of the condition causing your pain, it’s important to avoid the activities that make it worse while you’re recovering. As your pain improves, you can slowly return to your normal activities.

When should musculoskeletal chest pain be treated by a healthcare provider?

You should always see a healthcare provider to diagnose the cause of your chest pain, especially if it’s new. They’ll carefully rule out heart-related causes before diagnosing musculoskeletal chest pain.

Your diagnosis will tell you what kind of treatment you need and if you can treat it at home. Make sure to see your provider again if your condition doesn’t improve, or if you develop new symptoms.

A note from Cleveland Clinic

Any type of chest pain can be alarming, especially when you don’t know what’s causing it. But not all chest pain is related to your heart or lungs. Sometimes, it comes from your musculoskeletal system.

Musculoskeletal chest pain is usually not an emergency, but it’s still important to see a healthcare provider about it. They’ll investigate the possible causes and get you on the road to recovery.