Anterior chest pain may arise from trauma that causes bruising or fracture of ribs. Diagnosis is commonly possible from the history, confirmed by palpation of the painful area, radiology seldom being required for clinical purposes, although perhaps indicated for medicolegal reasons. On the other hand, it may be the result of herpes zoster, pleurisy, Tietze’s syndrome, coronary artery disease, pericarditis, or secondary carcinoma. In the first instance hypera esthesia of the affected area is often sufficient to make the diagnosis prior to the appearance of the herpetic vesicles. Pleurisy may usually be diagnosed from the history and auscultation, again seldom requiring radiology for clinical purposes. It should be remembered that chest pain may be provoked by vigorous coughing, in the absence of pleurisy. Tietze’s syndrome may be identified by clinical measures. Anterior chest pain is to be expected in coronary artery disease, with or without full-blown infarction, sometimes in association with neck or left arm pain. Pericarditis may be of insidious onset, not always easily identifiable clinically. Secondary carcinoma of a rib is again difficult to identify clinically, like the rare congenital cysts, often needing radiological confirmation. Asymmetry of local physical signs is unlikely in any of these conditions, in which there is no place for musculoskeletal procedures.


Herpes Zoster Transcutaneous Electrical Nerve Stimulation Polymyalgia Rheumatica Thoracic Pain Musculoskeletal Medicine 
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© Springer-Verlag London Limited 2006

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  • John K. Paterson

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