Chest Wall Pain Syndrome

Disease/Disorder

Definition

Chest wall pain syndrome (CWPS) is a clinically challenging condition that manifests as direct or referred pain perceived anywhere in the chest wall. Due to the potentially severe conditions presenting with “chest pain”, CWPS is frequently a diagnosis of exclusion and neuromuscular origins should only be considered after more urgent conditions have been reasonably excluded. As such, a thorough and structured diagnostic approach should be utilized.^1-3

Epidemiology including risk factors and primary prevention

An estimated 20-40% of the general population may be affected by chest pain in their lifetime with almost half of those that present to their primary care provider diagnosed with musculoskeletal causes.⁴ In the primary care setting, CWPS has an estimated mean age of 50.3±18 years, with nearly equal occurrence in men and women. The prevalence of specific conditions under the CWPS umbrella varies. Costochondritis is frequently cited, diagnosed in approximately 6-13% of primary care patients while Post-Mastectomy Pain Syndrome (PMPS), or the broader Post-Breast Surgery Pain Syndrome (PBSPS), has reported prevalence as high as 68%. Additionally, 83% of patients will also have associated comorbidity, including psychiatric dysfunction (50%), cardiovascular disease (33%), coronary disease (19%), and rheumatologic conditions (20.7%). Diagnoses also vary across the age spectrum with increasing incidence of intercostal neuralgia, often secondary to herpes zoster with increased age, while in adolescents, costochondritis accounts for 14% of chest wall pain.^1,5

Etiology

Chest wall pain can arise from anatomical structures and physiological processes. Understanding the underlying mechanism is crucial for accurate diagnosis and targeted treatment. Pain mechanisms can be nociceptive, neuropathic, and/or nociplastic. These mechanisms are not mutually exclusive, and, particularly in patients with chronic CWPS, there may be a mixed pain state involving contributions from multiple mechanisms. Failure to recognize and address all contributing mechanisms can lead to suboptimal treatment outcomes. Common musculoskeletal and neuropathic causes are listed in the tables below. Additional conditions that can manifest as CWPS include infection etiology (i.e. costochondritis, osteomyelitis, cellulitis), neoplastic (both benign and malignant), and inflammatory/rheumatic conditions (i.e. rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, fibromyalgia)

Musculoskeletal Causes – Table 1

Neuropathic Causes – Table 2

Patho-anatomy/physiology

Musculoskeletal: the chest is bordered by 12 ribs bilaterally, 12 vertebrae posteriorly, the sternum and xiphoid anteriorly, 2 clavicles superiorly, and an overlay of musculature and fascia giving function to these structures. This integrated framework provides strength, support, and protection of the viscera. Multiple bony areas are susceptible to fracture, and several joints and articulations can be injured. Once dysfunction occurs, collateral dysfunction can occur in the musculature. Equally, muscular strain/spasm will then restrict joints, creating discomfort at costochondral joints.

Neurology: the anterior rami of the first 11 thoracic spinal nerves form the intercostal nerves. These nerves course along the inferior border of the rib. If there is damage to the rib, rami, or coursing nerve, neural impingement may occur. Alteration to the skeletal formation of the thoracic outlet can also cause neural impingement, resulting in thoracic outlet syndrome. Nerve roots are also susceptible to viral infection and are a potential site for post-herpetic neuralgia.

Visceral: there can be pain referred from the viscera that appears to be chest wall oriented.² Visceral pain receptors are found in most of the viscera (thoracic, abdominal and pelvic) and its surrounding connective tissue. Noxious stimulus of these receptors activates a few unmyelinated afferent fibers which in turn activate many central neurons. Combined with somatic input this often produces a poorly localized pain response.¹⁶ Obstruction of hollow organs will produce a poorly localized, deep, cramping pain referred to multiple cutaneous sites. However, damage to the organ capsule or direct injury to the deep tissue may be more easily localized.²⁰

Disease progression including natural history, disease phases or stages, disease trajectory

Costochondritis: presents as sharp pinpoint tenderness that can occur bilaterally across the parasternal chest wall, most commonly localized over the costochondral and costosternal joints, in multiple areas on the same side of the sternum. It usually affects the 2^nd to 5^th ribs and is a self-limiting condition that resolves in days to weeks.^5,6

Herpes zoster/postherpetic neuralgia: once the varicella zoster virus is reactivated, burning with hyperesthesia presents, followed by a vesicular rash in 2-3 days. The rash is usually unilateral and limited to 1 to 2 dermatomes. The rash resolves in 2-4 weeks and neuralgia may set in.Postherpetic neuralgia is defined as 90 days of continual pain in a dermatomal distribution after the appearance of the rash. The pain is typically described as “shock-like” and “burning”. This neuralgia may be self-resolved but has also been shown to last indefinitely in some individuals.^5,6

Post-thoracotomy pain syndrome (PTPS): a disorder occurring after thoracotomy consisting of burning, hyperesthesia, and ache-like pain. Women have higher incidence. Only epidural placement prior to surgery changes disease course.²

Carcinoma: progression is based on tumor pathology, as well as risk for chest pain based on treatment methods.

Intercostal neuralgia: a condition caused by arthritis, trauma, and impingement, which results in a burning, sharp, stabbing discomfort in the appropriate dermatomal distribution. It may resolve on its own, although intercostal nerve block can expedite recovery.

Myofascial pain: usually caused by irritation of the thoracic fascia from trauma or muscle spasm. Its course is variable depending on treatment. Early physical therapy focusing on myofascial release is recommended.

Chest Wall Pain Syndrome – Multiple Conditions

• Cardiac
  • Acute Myocardial Infarction
  • Angina Pectoris
  • Aortic Regurgitation
  • Mitral Valve Prolapse
  • Hypertrophic Cardiomyopathy
  • Pericarditis
  • Sickle Cell Crisis
  • Thoracic Aortic Dissection/non-dissecting Aneurysm
• Pulmonary
  • Tracheal Bronchitis
  • Bronchiectasis
  • Pulmonary Embolism
  • Pneumonia
  • Pneumothorax
  • Pleurisy
  • Lung Abscess
  • Atelectasis
  • Carcinoma
  • Diaphragmatitis
  • Precordial Catch Syndrome
  • Hedblom Syndrome
• Gastrointestinal
  • Esophagitis
  • Gastroesophageal Reflux
  • Sphincter of Oddi Dysfunction
  • Esophageal Laceration/Rupture
  • Carcinoma
  • Paraesophageal Hiatal Hernia
  • Esophageal Motility Disorders
• Neurological
  • Intramedullary/Extramedullary Lesion
  • Epidural Spinal Cord Compression
  • Herpes Zoster/Postherpetic Neuralgia
  • Nerve Compression/Radiculopathy
  • Neurogenic Tumors
  • Complex Reginal Pain Syndrome
  • Intercostal Neuralgia
• Bone
  • Fractures
  • Neoplasm (Primary or Metastatic)
  • Arthritis
  • Ankylosing Spondylitis
  • Costochondritis
  • Costovertebral Arthritis
  • Diffuse Idiopathic Skeletal Hyperostosis
  • Inflammatory Diseases
  • Tietze Syndrome
  • Slipped Rib Syndrome
  • Xiphoidalgia
• Muscle
  • Myofascial Pain Syndromes
  • Muscle Spasms
  • Contractures
  • Dermatomyositis
  • Polymyositis
• Skin
  • Burns
  • Postoperative pain
  • Mastodynia
  • Post-Mastectomy Syndrome
  • Post-thoracotomy Syndrome
  • Scleroderma
  • Psoriatic Arthritis
  • Mondor Disease (an uncommon disorder characterized by superficial thrombophlebitis of the thoracoabdominal wall.
• Psychiatric
  • Conversion Reaction
  • Anxiety
  • Depression
  • Hypochondriasis
  • Operant Learning
• Extra-thoracic Disorders
  • Osteoarthritis
  • Thoracic Outlet Syndrome
  • Pancoast Syndrome
  • Gas Entrapment Syndrome
  • Peptic Ulcer Disease
  • Perforated Ulcer
  • Biliary Colic
  • Cholecystitis
  • Pancreatitis
  • Post-Radiotherapy Chest Pain
  • Subphrenic Abscess

Essentials of Assessment

History

A systematic approach to evaluating chest wall pain is essential, primarily focused on excluding life-threatening conditions before diagnosing a specific CWPS etiology. The initial approach should be to identify and exclude conditions requiring immediate intervention. Top areas to focus include the following^1,2,8

• Quality of the pain: squeezing or crushing, dull, aching, sharp, hot, or tearing.
• Location: right/left/bilateral, localized or diffuse.
• Radiation
• Intensity/Severity
• Timing/Duration: constant or intermittent, pattern
• Onset: sudden or gradual, event
• Aggravating/Alleviating factors: movement or position worsened, exertional pain, reproducible with palpation
• Previous events: similar or not, and how it differs.
• Associated symptoms: dyspnea, cough, fever, chills, nausea, vomiting, diaphoresis, palpitations, syncope, dizziness, fatigue, weight loss, anxiety, numbness, tingling, weakness, skin rash or lesion
• Past medical history, to include psychiatric/psychosocial history: current medications
• Social history: smoking, alcohol, illicit drug use, occupation, hobbies, recent strenuous activity or unaccustomed exercise, recent travel

Physical examination

A comprehensive musculoskeletal evaluation should be performed, to identify signs pointing toward specific CWPS diagnoses or alternative visceral causes.

• General Assessment: Observe overall appearance for signs of distress, pain behaviors, diaphoresis, pallor, or cyanosis. Measure vital signs including temperature, heart rate, respiratory rate, oxygen saturation, and blood pressure in both arms (checking for significant difference suggestive of aortic dissection).
• Inspection: Examine the chest wall for asymmetry, deformities (e.g., pectus excavatum/carinatum, scoliosis, kyphosis), surgical scars, swelling, erythema, ecchymosis, or skin lesions (e.g., vesicular rash of HZ, nodules). Observe respiratory pattern for retractions, paradoxical abdominal movement, or asymmetry of expansion. Inspect the neck for jugular venous distention (JVD). Note muscle wasting or hypertrophy.
• Palpation should include all structure of the chest wall: skeletal, soft tissue, and lymph nodes. Reproducibility of the patient’s specific pain with palpation is a strong association with musculoskeletal etiology.
• Range of Motion: active and passive ROM of the cervical and thoracic spine, shoulders and chest expansion. Measurement of chest expansion at the level of the fourth intercostal space – chest expansion >5 cm is normal whereas <2.5 cm may signify chest wall restriction and musculoskeletal pathology (i.e. ankylosing spondylitis, severe fibrosis).15
• Neurologic: sensory, motor, reflexes
• Cardiopulmonary: auscultation, percussion, pulsus paradoxus, hepatojugular reflux, peripheral edema, peripheral pulses

Laboratory studies

Diagnostic tests play a crucial role in excluding serious underlying pathology, confirming specific diagnoses, and guiding management.

• Complete blood count: leukocytosis (pneumonia, chest wall infection, osteomyelitis), anemia, renal function (if considering contrast imaging or medications)
• Comprehensive metabolic panel
• Cardiac markers: indicated in acute chest pain setting to rule out myocardial injury or infarction
• D-dimer: in a low-probability setting to help exclude pulmonary embolism
• C-reactive protein (CRP), Sedimentation rate (ESR): can be elevated in systemic inflammatory conditions, infections, pericarditis, and Tietze’s syndrome
• Other specific tests: Lipase (pancreatitis), procalcitonin (bacterial infection), rheumatologic serologies (ANA, RF, anti-CCP, HLA-B27), blood cultures (sepsis), arterial blood gas (respiratory compromise).

Diagnostic studies and imaging

In patients with nonspecific chest pain, an electrocardiogram (ECG) is used to detect signs of cardiac ischemia, injury, infarction, or pericarditis. Imaging studies are nonspecific for CWPS but may aid in other diagnoses. Imaging will be necessary to rule out other life-threatening conditions. Possible studies include the following

• Chest radiograph: often the first imaging test obtained
• Ultrasound (US): evaluating superficial chest wall structures. Can visualize costochondral junctions (may show cartilage thickening/edema in Tietze’s), rib cortex (detecting fractures, callus formation), muscles (tears, hematomas), subcutaneous tissues (cellulitis, abscess, seroma), and pleura (effusions, thickening). Dynamic ultrasound is the imaging modality of choice for confirming slipping rib syndrome by visualizing rib subluxation during maneuvers. US can identify some neuromas as hypoechoic nodules, and pain reproduction with transducer pressure (“ultrasound trigger sign”) can be diagnostic.16
• Computed tomography (CT): allows a more detailed evaluation of chest wall lesions
• Magnetic resonance imaging (MRI): offers superior soft-tissue contrast resolution compared to CT, making it invaluable for characterizing soft tissue masses, assessing tumor extent (including neurovascular involvement), and evaluating muscle/tendon injuries. It is the preferred modality for evaluating the spinal cord and nerve roots (thoracic radiculopathy/myelopathy) and the brachial plexus (RIBP, tumor infiltration). MRI can detect inflammation in costochondritis/Tietze’s (cartilage edema, enhancement), osteomyelitis, and fluid collections like hematomas (often showing characteristic signal intensities like fluid-fluid levels).
• Bone Scan (Nuclear Scintigraphy): Detects areas of increased osteoblastic activity and blood flow. Sensitive for detecting stress fractures, metastatic bone disease, osteomyelitis, and inflammatory arthritis. Can show increased uptake in costochondritis, Tietze’s syndrome, and slipping rib syndrome, but findings are non-specific.
• Positron Emission Tomography (PET/CT): Primarily used in oncology for staging, detecting recurrence/metastasis, assessing treatment response, and guiding biopsy to metabolically active tumor regions.
• Electrodiagnostic Studies (EMG/NCS): evaluates the function of peripheral nerves, neuromuscular junctions, and muscles. It is indicated when a neuropathic component to CWPS is suspected

Early predictions of outcomes

In patients with postherpetic neuralgia, when antiviral medication is dispensed within the first 72 hours of onset, there is a decreased likelihood of prolonged neuralgia. The greater the age of onset of a shingles outbreak, the greater the likelihood the patient will develop a prolonged neuralgia.²

Environmental

In cases where physical motions or body positions cause symptom exacerbation, it may be necessary to make environmental or postural modifications. Changes may include ergonomic adjustments or change in job assignment.

Social role and social support system

Understand your patient’s social and family needs. Anxiety results in frequent visits to the primary care physician and/or emergency room. The time commitment of seeing multiple physicians and undergoing testing procedures may pose a financial hardship.

Rehabilitation Management and Treatments

Available or current treatment guidelines

Treatment guidelines have been documented in Bonica’s Management of Pain and Waldman’s Pain Management Vol. 1, but there is no recent guideline or consensus for management, which is a potential avenue for future collaboration/research.^2,3 Treatment strategy depends heavily on the specific underlying musculoskeletal cause. Many conditions are initially treated with nonsteroidal anti-inflammatory drugs/COX-2 inhibitors, ice, and heat.

Conservative Management: first line treatment for musculoskeletal chest wall conditions can include activity modification, analgesics (i.e. acetaminophen, nonsteroidal anti-inflammatory drugs), heat/ice application, patient education.

Physical Therapy and Rehabilitation: Stretching, strengthening, and mobilization techniques can be particularly beneficial for myofascial etiology such as costochondritis and rib dysfunction. Further patient education and continued independent programs for objectives such as postural correction may be needed. Additional therapeutic modalities like ultrasound, TENS, or cold laser may also be considered for symptomatic improvement.^3,7,10

Pharmacological treatments: beyond simple analgesics, topical medications and neuropathic agents may be needed based on etiology. In cases of severe acute pain or severe cancer related chest wall pain, opioid may be considered

Interventional Procedures: targeted treatment using local anesthetics with or without steroids may be options. Targets can include trigger point injection, intercostal nerve blocks, paravertebral blocks, and injections into specific joints. Ultrasound guidance is often recommended for accuracy and safety. Nerve ablation and neurolysis can be utilized for longer-lasting relief than nerve blocks. Increasing use of platelet-rich plasma (PRP) and neuromodulation (spinal cord stimulation (SCS), peripheral nerve stimulation (PNS)) are opportunities for continued research in efficacy.^2,3

Psychological Approaches: Cognitive Behavioral Therapy (CBT) can be effective for managing chronic non-cardiac chest pain, addressing associated anxiety or depression, and improving coping skills. Chronic conditions may benefit from an interdisciplinary pain management program that includes physical therapy, occupational therapy, nursing, psychology, and patient education with goals of functional restoration and learning pain management techniques.

Alternative Therapies: acupuncture and TENS are sometimes used, though high-quality evidence is often limited. Chiropractic manipulation may also be considered.

Coordination of care

Chronic CWPS may need interdisciplinary care coordinated by their primary care physician, with input from physical and occupational therapists, other consulting physicians (cardiologists/pulmonologists), neuropsychologists, psychiatrists, and the patient’s family support network.

Patient & family education

When the etiology of CWPS is from a musculoskeletal complaint, such as costochondritis, the patient and family should be reassured that symptoms will typically resolve in weeks or months.

If CWPS is related to a secondary cause, which is not benign and more likely chronic, the patient should be given proper access to support for coping strategies, especially in the later stages of their disease.

Cutting Edge/Emerging and Unique Concepts and Practice

In cases of thoracic nerve radiculopathy/neuropathy, cryoablation has recently been used. New clinical trials of cryoablation with a video-assisted thoracoscopic technique are being undertaken to improve accuracy and efficacy and concomitantly decrease the need for repeat ablation.⁹

In patients with esophageal hypersensitivity as the cause of their pain, several studies of intravenous infusion of theophylline (an adenosine receptor antagonist) have shown to have significant improvement in pain when compared to placebo.¹¹

The use of intravenous ketamine as treatment modality for CRPS and neuropathic pain has been gaining popularity but still lacks high quality evidence.¹⁴ Findings from a systematic review suggested clinically effective pain relief in the short term, but further studies are need to prove long-term efficacy of ketamine infusion in the treatment of CRPS.¹⁵

Gaps in Evidence-Based Knowledge

Despite the vast number of admissions for chest pain, the process involved with the diagnosis of non-cardiac causes for chest pain very often ends up as a diagnosis of exclusion. The sheer number of possible diagnoses/factors for chest pain make high quality randomized, double blinded studies extremely hard to conduct. As a result, definitive conclusions about chest wall pain are difficult to reach due to the lack of sufficient evidence. More robust studies are needed for physical therapy techniques, interventional procedures (i.e. RFA, cryoneurolysis, neuromodulation, PRP), alternative therapies (i.e. TENS, acupuncture), and surgical techniques for conditions like slipping rib syndrome. Additional research for optimization of individualized treatment strategies and understanding factors influencing prognosis and recovery will help improve diagnostic accuracy, develop evidence-based treatment guidelines, and ultimately enhance outcomes for patients experiencing chest wall pain syndrome.

References

1. Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract. 2007; 8:51.
2. Gundamraj NR, Richeimer S. Chest wall pain. In: Loeser JD, Butler SH, Chapman CR, et al. Bonica’s Management of Pain. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2001:1142-1168.
3. Waldman SD. Pain Management. Vol. 1. Philadelphia, PA: Saunders/Elsevier; 2007.
4. Stowell, Justin & Walker, Christopher & Chung, Jonathan & Bang, Tami & Carter, Brett & Christensen, Jared & Donnelly, Edwin & Hanna, Tarek & Hobbs, Stephen & Johnson, Braeden & Kandathil, Asha & Lo, Bruce & Madan, Rachna & Majercik, Sarah & Moore, William & Kanne, Jeffrey. (2021). ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology. 18. S394-S405. 10.1016/j.jacr.2021.08.004.
5. Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78. PMID: 34264599.
6. Saguil A, Kane S, Mercado M, Lauters R. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017 Nov 15;96(10):656-663. PMID: 29431387.
7. Son MB, Sundel RP. Musculoskeletal causes of pediatric chest pain. Pediatr Clin North Am. 2010;57:1385-1395.
8. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80:617-620.
9. Miyazaki T, Doi R, Matsumoto K. Post-thoracotomy pain syndrome in the era of minimally invasive thoracic surgery. J Thorac Dis. 2024 May 31;16(5):3422-3430. doi: 10.21037/jtd-24-158. Epub 2024 May 20. PMID: 38883660; PMCID: PMC11170434.
10. Arends S, Böhmer AB, Poels M, Schieren M, Koryllos A, Wappler F, Joppich R. Post-thoracotomy pain syndrome: seldom severe, often neuropathic, treated unspecific, and insufficient. Pain Rep. 2020 Mar 4;5(2):e810. doi: 10.1097/PR9.0000000000000810. PMID: 32440607; PMCID: PMC7209820.
11. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 2nd ed. Media, PA: Lippincott Williams and Wilkins; 1983:801-825.
12. Hunt I, Eaton D, Maiwand O, Anikin V. Video-assisted intercostal nerve cryoablation in managing intractable chest wall pain. J Thorac Cardiovasc Surg. 2010;139:774-775.
13. Wertli M, Ruchti K, et. al. Diagnostic indicators of non-cardiovascular chest pain: a systemic review and meta-analysis. BMC Medicine 2013, 11:239.
14. Hershcovici T, Achem SR, et al. Systemic review: the treatment of noncardiac chest pai Alimentary Pharmacology and Therapeutics 2012; 35; 5-14.
15. Stochkendahl M, et al. Reconstruction of the decision-making process in assessing musculoskeletal chest pain:an exploratory study using recursive partitioning. Journal of Manipulative and Physiological Therapeutics 2012; 35; 3:184-195.
16. Van Tassel, D. McMahon, L. E., Riemann, M., Wong, K., & Barnes, C.E. (2019). Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal radiology, 48 (5), 741-751.
17. O’Connel l N, W and B, et a l. Interventions for treating pain and disability in adults with  complex regional pain syndrome- an overview of systemic reviews. Cochran Database of Systemic Reviews. 2013.
18. Zhao J, Wang Y, Wang D. The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systematic Review and Meta-analysis. Curr Pain Headache Rep. 2018 Feb 5;22(2):12. doi: 10.1007/s11916-018-0664-x.
19. Cervero F. Visceral nociception: peripheral and central aspects of visceral nociceptive systems. Philosophical Transactions of the Royal Society B: Biological Sciences. 1985: 308(1136): 325-337.
20. Markman J , Narasimhan S. Merck Manual: Overview of Pain. April 2014.

Bibliography

Baillie J. Sphincter of Oddi. Curr Gastroenterol Rep. 2010;12:130-134.

Boeti C, Arentz C, Klimberg VS. Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated. Ann Surg Oncol. 2010;17 Suppl 3:321-324.

Labra C, Collen J, Cho K, Mikita J. An uncommon cause of chest pain in the deployed soldier. Mil Med. 2011;176:414-419.

Mohammad AF, Ambrose N, Hamnvik OP, Kearns G. Meticillin-sensitive Staphylococcus aureus costochondritis in a healthy man. Nat Rev Rheumatol. 2009;5:708-710.

Sgouros SN, Pereira SP. Systematic review: sphincter of Oddi dysfunction–non-invasive diagnostic methods and long-term outcomes after endoscopic sphincterotomy. Aliment Pharmacol Ther. 2006;24:237-246.

Sik EC, Batt ME, Heslop LM. Atypical cest pain in athletes. Curr Sports Med Rep. 2009;8:52-58.

Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010;94:259-273.

Yakovlev AE, Resch BE, Karasev SA. Treatment of cancer-related chest wall pain using spinal cord stimulation. Am J Hosp Palliat Care. 2010;27:552-55.

Original Version of the Topic

Jeffrey E. Oken, MD, Steve Dugan, DO. Chest wall pain syndrome. 9/20/2013.

Previous Revision(s) of the Topic

Jeffrey E. Oken, MD, Aaron Hanyu-Deutmeyer, DO. Chest wall pain syndrome. 7/28/2017.

Vikramjeet Saini, MD, Amanpreet Saini, MD, Taylor Stinnett, DO, Anmar Dalati, DO. Chest Wall Pain Syndrome. 7/28/2022

Author Disclosures

Ellen Hoover, MD
Nothing to Disclose

Mahek Nasser
Nothing to Disclose

Megan Clark, MD
Nothing to Disclose