Noncardiac and Extrapulmonary Causes of Chest Pain

When you have chest pain, the first thing that comes to mind is heart problems. For this reason, an emergency room or cardiologist is consulted first. When cardiac examinations and tests result in normal results, the patient is referred to chest diseases for possible lung diseases. In some patients, no problems can be detected in the lung. But the pain is there. Problems in the abdominal organs such as stomach and gallbladder can also be felt as chest pain. For this reason, an internal medicine examination is also performed. Thus, all vital organs are controlled. If the source of pain cannot be determined as a result of all these evaluations, the patient is usually referred to a physical therapy and rehabilitation physician.

In fact, most chest pains are related to problems in the musculoskeletal system. Problems in the ribs, breastbone, cartilage tissue, back spine, nerve fibers, and chest muscles can cause pain. These problems are often not life-threatening and may heal on their own. Still, it’s agonizing for patients as it causes doctor to doctor to wander around. Let’s look at the relatively little-known musculoskeletal causes of chest pain.


This condition, also called costosternal syndrome or anterior chest wall syndrome, is characterized by pain and tenderness in the joints where the ribs attach to the breastbone. The pain is usually limited to a certain point and is on the left. Sensitivity is seen when pressed with finger. There are no signs of inflammation such as swelling, redness, temperature increase. It may occur due to strain due to heavy activities of the arms. Sometimes it may develop following upper respiratory tract infections. It is also suggested that a slight movement (dislocation) in the joint where the rib attaches to the spine in the back may cause rotation in the rib bone, and this rotation effect increases along the rib and causes strain on the anterior joint.

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lower rib pain syndrome

Lower rib pain syndrome or slipped rib syndrome affects the lower ribs. In this syndrome, pain is felt in the lower part of the chest or abdomen. The connective tissue that connects the eighth, ninth, or tenth ribs to the breastbone (sternum) relaxes. It may develop as a result of trauma. It causes pain by disturbing the nerves near the increased rib bone. Sometimes a painful crackling sound can be heard from the tip of the rib. The movements of the affected rib may be increased compared to the other ribs. In its treatment, it is generally recommended to avoid activities that increase pain so that the rib is given an opportunity to heal. If rest does not improve, surgery may be required to stabilize the rib bone.

precordial capture

Precordial catch, or “precordial catch” in English, is a common harmless condition. It usually occurs in children and teenagers. A sudden, sharp chest pain is often felt on the left side. Typically occurs at rest, the pain is exacerbated by breathing when it occurs. It may last for a few seconds or minutes, then it goes away on its own. This condition, the cause of which is unknown, has no medical significance.

Sternoclavicular joint pain

Pain due to calcification (osteoarthritis), infection or rheumatic diseases may occur in the sternoclavicular joint, which is the joint where the collarbone is attached to the breastbone. Dislocation of the joint as a result of trauma can also cause pain.


Fibromyalgia , a disease characterized by widespread musculoskeletal pain in the body , can also cause chest pain as well as many other complaints.

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rheumatic diseases

Chest wall pain may occur in rheumatic diseases such as ankylosing spondylitis, psoriasis-related rheumatism (psoriatic arthritis), rheumatoid arthritis. Particularly in ankylosing spondylitis and psoriatic arthritis, the expansion capacity of the chest wall can be reduced by holding the ribs at the joints. Chest wall pain is not usually the only finding in these diseases. When there are symptoms such as pain and swelling in the knee, ankle, finger and wrist joints, low back pain and stiffness, heel pain, inflammation of the eye called uveitis, the diagnosis shifts to rheumatic diseases.

stress fractures

Stress fractures of the ribs can occur when exposed to strenuous and repetitive activities that affect the upper part of the body due to occupation or sports. Bone resorption and vitamin D deficiency can also predispose to stress fractures.


One of the musculoskeletal causes of chest pain that is relatively easy to recognize is injuries resulting from trauma. There is sensitivity to touch in the traumatized area. The pain may increase with breathing and movement. About half of all rib fractures are visible on X-rays, the remainder not. Sometimes, although the first films are normal, the callus tissue formed due to the healing of the fracture can be seen in the films in the following weeks. Trauma-related chest pain may occur with coughing in the elderly, and may also occur due to difficulties in sportive struggles, although it is not a direct severe blow to the rib cage in young people. Even if the trauma does not cause a fracture, it can cause muscle strain. Activities such as heavy lifting, painting the ceiling, cutting wood can cause strain and pain in the chest muscles.

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disc herniation in the back

Back hernia, called thoracic disc herniation, although rare, is a cause that can cause back and chest pain. It most commonly occurs in the lower half of the back in men in their 40s. Before the hernia occurs, there may be back pain due to disc wear for months. As a result of the hernia compressing the nerves, pain radiating to the front of the chest may occur. Back hernias can carry the risk of compressing the spinal canal and causing paralysis in the legs.


Advanced cancers that have spread to the chest wall can cause chest pain. Most commonly, breast cancer and lung cancer can cause this condition. Very rarely, cancer or benign tumors originating from the rib bone can also cause pain.

sickle cell anemia

Patients with sickle cell anemia may experience chest wall pain. This pain may develop due to blockages in the vessels in the rib bones. Once the sickle cell anemia crisis is under control, the pain subsides.

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