Pain in the muscles of the chest

Pain in the back, chest in medicine is determined by the general concept - dorsalgia. Dorsalgia is considered one of the most common syndromes with which doctors of various specializations work - from a surgeon, a neurologist to a gastroenterologist, a vertebrologist and other directions. A pain symptom in the chest zone, including pain in the muscles of the chest, is called thoracalgia and is noted in 85-90% of people regardless of age or social status. Such a syndrome has different causes and is not an independent nosological unit. In order to classify the pain in the muscles of the chest requires a complex, comprehensive diagnosis, including specific anatomical, topographic designations of the localization of pain. Thoracalgia, in turn, is as common as abdominalgia - abdominal pain, in contrast to acute pain abdominal symptoms, chest pain in 25-30% of cases is due not to the pathology of internal organs, but to the defeat of skeletal muscles, hence, to myalgia.

[1], [2], [3]

Causes of pain in the muscles of the chest

The causes of thoracology as well as the causes of pain in the muscles of the chest can be associated with both vertebrogenic pathologies, are caused specifically by muscular lesions, and neurogenic factors, as well as diseases of the heart and gastrointestinal tract. Actually thoracalgic syndromes are infringement, irritation or compression of the intercostal nerves, the result of which is muscular spasm and pain of various character, localization and duration. Thus, any reason for thoracology in one way or another may be a factor that provokes pain in the muscles of the breast.

There are several well-studied clinical forms of thoracalgia vertebrogenic, which are diagnosed in 65-70% of cases: 1.

Functional thoracology, caused by degenerative changes of the spine in the lower cervical region. Pain in the chest, in the nerve endings and muscles is localized in the upper zone and irradiates to the neck, shoulder, often in the arm. The symptom is directly related to the condition of the spine and can be amplified with various movements, physical activity 2.

Thoracalgia caused by degenerative processes in the upper-thoracic spine. Syndrome differs from diffuse pain in the chest space, between the shoulder blades, depends on the depth of breathing, but does not change at all due to movements due to low mobility.

Pain in the chest, in the back, associated with the lesion of the scapula. The pain is characterized by stabbing, sharp, cutting sensations, depends on the depth of breathing, partly on movements and irradiates towards the direction of the intercostal nerve endings 4.

Thoracalgia, caused by defeat, compression of the front of the chest. Painful, prolonged, localized in the middle or lower part of the chest, depends on the motor activity

It should be noted that the causes of pain in the muscles of the breast can be both vertebrogenic and non-recurring: 

• Osteochondrosis.
• Kifoscoliosis.
• Xifoidalchia.
• Injuries of the spine (thoracic region).
• Syndrome Titz.
• Infectious diseases (herpes).
• Hernias, infringements, protrusions of disks.
• Vertebro-Muscular Coronary Syndrome.
• Myalgia associated with overexertion, lifting or moving of weights.
• Myofascial pain syndrome is skeletal-muscular thoracology.

[4], [5], [6], [7]

Why do chest muscles hurt?

What is the pathogenetic mechanism of the syndrome, why does the chest muscle ache?

Any of the etiological factors provoking thoracalgia leads to irritation, infringement, squeezing of the nerve endings, which are surrounded by ligaments, fasciae and muscles. Irritation can cause inflammation and swelling of the nerve, it can damage - nerve tear, there may be compression, compression of the nerve end. A damaged nerve no longer fulfills its function, it can only transmit a pain signal to nearby soft tissues, most often to the muscles.

The reasons explaining why the muscles of the chest hurt, there may be myofascial manifestations - skeletal-muscular thoracalgia. Myofascile pain syndrome in the chest is directly related to the prolonged physical stress of a certain group of muscles, the symptom is amplified and activated by awkward twists and turns. But most painfully manifests itself in the palpation of the so-called trigger zones, which are diagnostically important and determine the proper MFBS. Muscle irritation in the trigger zones is accompanied by either a clearly localized or reflected pain, which can spread out beyond the trigger point. Among the causes of the MFBS can not only be purely physical factors, myofascial chest pains are often caused by latent rheumatic diseases, osteochondritis, radiculopathy, neurogenic pathologies, metabolic disorders.

In any case, what would not be provoked by the pain symptom in the muscles of the breast, there is one pathogenetic cause - a nerve damage that can lead to its swelling, tearing or compression. From the type of damage to the nerve endings, the character, localization and duration of the pain, that is, the symptoms proper, depends.

Why does the muscle ache under the chest?

If the muscle hurts under the breast, it can mean a lot of problems not associated with a purely muscular syndrome. 

• Titze syndrome or perichondritis, costochondritis, anterior thoracic wall syndrome and other variants of names. Judging by the variety of definitions of the syndrome, its etiology is still unspecified, but the clinical manifestations have been studied quite well. According to the author's version, the disease first described in detail the syndrome at the beginning of the last century, the disease is associated with an alimentary-dystrophic, food factor, that is, with a metabolic disorder and a degeneration of the cartilaginous structure. There are also theories explaining chondrite with permanent traumatization, infectious and allergic diseases. Titze syndrome is characterized by acute, shooting pain in the area of attachment of the sternum to the costal cartilage, more often in the zone of the II-IV rib. Inflamed cartilage provokes a pain symptom, similar to an attack of angina, that is left-sided pain. However, it is often noted and complaints about the fact that the muscle hurts under the breast to the right, also often there is a symptomatology resembling the signs of cholecystitis, gastritis, pancreatitis. 
• The chronic form of the Tietze syndrome is called xifoiditis or xypoid syndrome, when the pain is localized in the zone of the xiphoid process, less often in the lower part of the breast (under the breast). The pain radiates into the epigastrium, into the zone between the scapula, is strengthened in motion, especially when tilted forward. A characteristic symptom of xifoiditis is an increased pain sensation in overeating, overfilling of the stomach. In contrast to gastrointestinal pain, xifoiditis manifests itself clinically in a sitting position, semi-sitting. 
• Hernia of the esophagus (diaphragm) often provokes pain, similar to the muscle spasms at the bottom of the chest. The pain is felt as a colic, localized in the vaginal space, but can move to the area under the chest or in the side, sometimes resembling an attack of angina. The symptom depends on the position of the body, strengthens in a horizontal posture and subsides in a vertical position, which helps to distinguish it from anginal symptoms.
• The abdominal form of musculoskeletal pain in the chest may indicate an atypical development of myocardial infarction. Pain is localized in the upper abdomen, under the breast, accompanied by a feeling of nausea, bloating. The clinic of such a syndrome is very similar to the signs of an intestinal obstruction, which greatly complicates both the diagnosis and the timeliness of rendering assistance.

In general, if the muscle hurts under the chest, at the bottom of the chest, the patient should immediately consult a doctor, as often such signs indicate serious, sometimes life-threatening conditions. Very rarely the localization of muscle pains under the chest concerns the myofascial syndrome.

Symptoms of pain in the muscles of the chest

The main signs of thoracology, including symptoms of pain in the muscles of the chest: 

• Pain sensation, localized on the right or left in the chest. The pain is permanent, it feels like a shroud, shooting, paroxysmal. Pain can spread in the direction of intercostal nerve endings, depends on many types of movement - turns, inclinations, coughing, sneezing, breathing.
• Pain of burning character, accompanied by numbness, radiating to the area of the scapula, in the heart, less often in the lower back. The sensation of burning can spread in the direction of the nervous branches. Often such a symptom is characteristic of intercostal neuralgia.
• Pain associated with the muscles of the shoulder girdle, the muscles of the back extensor, the muscles of the scapula. This symptom is not associated with compression or compression of the nerve, rather it is caused by hypertension of the muscle tissue, provoked by overstrain both dynamic and static. The pain is felt as accruing, aching, amplified by the load on the damaged muscle (twists, slopes, lifting of gravity).
• True thoracology should be differentiated with intercostal neuralgia, which is a frequent diagnostic problem. In addition, the symptoms of chest pain are very similar to the pain symptoms of other syndromes - cervicalgia (neck pain) and thoracobrachialgia (pain in the shoulder, arm). 
• Intercostal neuralgia is characterized by acute, piercing pain, most often localized in the anterior chest zone.
• Thoracobrahialgia is characterized by irradiating pain in the arm.
• Cervicalgia is specific for the onset of pain symptoms directly in the neck, if pain spreads into the thoracic zone, it is characterized as cervicorothoracology.

To determine the exact syndrome for musculoskeletal chest pains use this scheme:

Definition of the syndrome	Zone of localization of trigger points, determined by palpation	Feeling and nature of pain
Breast syndrome	Chest zone, synchondrosis	The pain is felt in the depth, in the wretched space
The costal-chest syndrome	Intercostal muscles (zone II of the 3rd rib), as well as rib-chest joints, more often on the left	Pain of a constant, noisy character, the symptom depends on many movements - turns, slopes, coughing, sneezing
Xifoidalchia	Zone of the xiphoid process	Pain, which depends on the position of the body. Strengthens in the bending and extension of the body, in squatting, the position of the body - polisidya, depends on abundant food (large volume)
Anterior costal syndrome	Zone VIII-X-th rib, area of cartilage margin	Strong, acute pain at the bottom of the chest, in the precordial zone, is amplified in motion, with bends
Titze Syndrome	Zone II-III of the rib joint, palpated hypertrophied cartilage	The pain is long, aching, does not subside at rest, in the area of compacted cartilage

Myofascial syndrome is the most common cause of a pain symptom in the chest that is not associated with vertebrogenic pathology.

Myofascial dysfunctions are characterized by chronic course, can be localized in different zones, but rarely migrate beyond certain diagnostic trigger points. It is these points that are pathognomonic criteria that determine the MFBS - myofascial pain syndrome. When palpation in the trigger zones, a painful compaction is revealed, a muscular lump in size from 2 to 5-6 millimeters. If the pain point is a mechanical pressure from the outside, and because of body movements, the pain intensifies and can be reflected in nearby soft tissues. The characteristic signs of the MCFS, which determine the symptom - hurt the muscles of the chest: 

• The symptom of reflection is a "jump", when the pressure increases and grows when the muscle is compressed.
• Pain can increase spontaneously when the affected muscle is loaded (active trigger point) under load, pressure. 
• Feeling of stiffness, aching pain is typical for latent trigger points. The pain symptom limits the amount of movement of the chest muscle.
• Pain with MFBS often depresses muscle function, provokes its weakness.
• Myofascial pain can be accompanied by neurovasculature symptoms, characteristic of compression syndromes, if a nerve, a neurovascular bundle is located between the trigger points.

The reasons for the development of the MSFE and the muscles of the chest hurt, can be: 

• Acute muscle overload, stretching caused by physical exertion.
• Static posture, prolonged preservation of the body's antiphysiological position.
• Subcooling.
• Congenital anatomical skeletal anomaly (asymmetry of the pelvis, different length of the legs, asymmetry of the structure of the ribs, and so on).
• Metabolic disorders.
• Viral, infectious diseases, in which MSFES is a secondary syndrome.
• Rarely are psychogenic factors (depression, phobias).

It should be noted that the most common complaint is "hurt the muscles of the chest" in those who begin to engage in sports, training, especially for power types - bodybuilding, that is, physical overload of the spinal column and surrounding muscles. Unfortunately, the remaining causes of pain symptoms in the chest often remain undiagnosed in a timely manner, the pain becomes chronic, nonspecific, which makes it difficult to identify the true cause and the appointment of adequate treatment.

Diagnosis of pain in the muscles of the chest

Pain in the muscular tissue of the breast can indicate various diseases, including life-threatening conditions. Therefore, the diagnosis of pain in the muscles of the breast should not only be timely, but also maximally differential, accurate, which is quite difficult, given the polysymptomicity and variability of sensations of this nature. According to statistics, musculoskeletal pain in the chest is the result of such pathologies: 

• Cardialgia - 18-22%.
• Osteochondrosis and other vertebrogenic pathologies - 20-25%.
• Diseases of the digestive system - 22%.
• True benign muscular diseases, more often MFBS (myofascial pain syndrome) - 28-30%.
• Injuries - 2-3%.
• Psychogenic factors, depression - 3-8%.

In order to quickly differentiate purely muscular pathologies from coronary cardialgia and other serious diseases, the doctor conducts and appoints the following types of examination: 

• The collection of an anamnesis, including hereditary, the determination of the objective cause of pain, its connection with eating, the neurogenic factor, the position of the body, and so on.
• Exclusion or confirmation of typical signs of angina pectoris.
• Electrocardiogram.
• Samples are possible with the use of anti-angiogenic drugs.
• Identification of symptoms of possible vertebral diseases. Visually, the deformity of the spine, its biomechanical disturbances is determined, palpation reveals muscular clamps at trigger points. In addition, the limitation of movement, the presence of areas of hyperesthesia.
• Exclusion or confirmation of degenerative changes in the spine with the help of an X-ray.
• Conducting a manual examination of muscle tissue.

If predefined by MFBS (myofascial pain syndrome), the localization of pain can determine the affected muscle and make a more precise therapeutic strategy.

Zone of pain symptom	Muscles
Anterior part of thorax	Large, small, ladder, sternoconstrictor, sternocleid (mastoid) muscle
Posterior zone of sternum, upper part	Trapezoidal, as well as scapular-lifting muscles
Middle chest, middle	The rhomboid muscle and latissimus muscles of the back, the posterior upper jagged muscle, as well as the anterior dentate and trapezius muscles
The posterior surface of the chest, the lower zone	Iliac-rib and posterior inferior muscularis

In addition, the diagnosis of pain in the muscles of the breast takes into account such conditions and signs:

• The relationship of pain with the position and posture of the patient's body, as well as with the movements of the hands.
• Absence or presence of roentgenologic signs of vertebrogenic syndrome, or muscular-tonic manifestations.
• The presence of concomitant symptoms, including feelings of anxiety, fear.
• Absence or presence of osteofibrosis areas in the upper chest.
• Absence or presence of pronounced abnormalities on the ECG.
• Response to the use of anticoagulants and nitroglycerin.
• Dependence of pain on massage, biomechanical correction.

Summarizing, it can be noted that an experienced doctor always remembers the so-called "red flags" in the process of diagnosing dorsalgia in general and thoracology in particular. This allows you to quickly exclude or confirm serious pathologies and begin adequate therapeutic activities.

[8], [9], [10], [11], [12], [13], [14]

Treatment of pain in the muscles of the chest

If vertebrogenic nature of pain in the muscles of the chest is revealed, the treatment is directed to the main, provoking factor. The pain is stopped either by injection blockades with the use of corticosteroids or by the appointment of anti-inflammatory drugs in tablet form, it all depends on the nature of the pain. The stage of remission involves acupuncture, traction therapy, massage, physiotherapy exercises.

Titze syndrome is treated with warming procedures and ointments containing NSAIDs. If the pain is intense, infiltration with local analgesic drugs is prescribed, more often novocaine, less often corticosteroids.

The costal-chest syndrome is treated with blockade of intercostal nerve endings, then the patient's condition is massage, exercise therapy.

Treatment of pain in the muscles of the breast with sternocleid syndrome (hyperostosis) is the use of anti-inflammatory non-steroid drugs, both in tablet form and in the form of ointments. Also shown are warming compresses, physiotherapy and muscle strengthening exercises.

Myofascial syndrome is treated in a complex way, since it is necessary to influence all the numerous links of the process. Anesthetics, NSAIDs, antidepressants, mielorelaxants, massage and stretching of the affected muscles, thermal procedures, electrostimulation and even injections of botulinum toxin are prescribed. Local applications with dimexid and lidocaine, post-isometric relaxation, manual gentle therapy are effective.

In general, the treatment of pain in the muscles of the chest is a competent combination of drug therapy and non-pharmacological methods, which allows not only to stop the pain symptom, but also to significantly reduce the risk of relapse of the syndrome.

Prevention of pain in the muscles of the chest

To date, unfortunately, there are no special, generally accepted recommendations for the prevention of pain in the muscles of the chest. This is due to the polysymptomatics and the variety of causes that provoke the pain syndrome.

Obviously, the rules that allow avoiding traumatization, illnesses throughout life, concern compliance with the norms of a healthy lifestyle. However, even those who constantly care about their health, are not immune from any pain in the muscles of the body, including in the chest. Nevertheless, given that most of the factors that trigger myalgia are associated with degeneration of the spine and overstrain, muscle strain, you can offer these tips:

• It is necessary to lead an active way of life taking into account the total hypodynamia inherent in our century of high technologies. A sedentary, inactive way of life is the right way to the development of all types of osteochondrosis, respectively, and to muscle aches.
• If the pain in the muscles of the chest is diagnosed, the cause is determined and treatment is passed, then all medical recommendations must be followed to exclude the possibility of relapses.
• Given the close relationship of myalgia and the state of the respiratory, digestive system, one should adhere to the rules of healthy eating, abandon bad habits - alcohol abuse, smoking.
• In sports, you should follow the rule of reasonable distribution of the load and the ratio of their own capabilities with the sport task.
• Given the close relationship of all types of myalgia to the state of the nervous system and the fact that about 15% of its causes are due to psychogenic factors, it is necessary not only to save nerves, but to regularly engage in autogenic training, to know and perform antistress, relaxation exercises.
• At the first disturbing painful sensations it is necessary to address to the doctor, to be surveyed, as at times timely diagnostics and treatment help to avoid not only development of a painful symptom, but also serious, life-threatening conditions.

Pain in the chest muscles is not a specific symptom that indicates a specific problem, a disease, so self-medication can only translate the acute nature of the pain into chronic. Constant discomfort in the chest interferes with full-time work, reduces the quality of life, while a cured disease in time helps to fully experience all the benefits of recovery, that is, returned health.