I recently had a patient with an unusual pain presentation in the right anterior chest. In general, when we see patients with chest pain, our mind jumps towards cardiac or pulmonary issues, rightfully so. However, there are musculoskeletal structures that can refer here as well. It is imperative that we are able to identify the involved structure as it may dictate how the treatment is performed.
Some of the more common mechanical issues include: rib dysfunction, intercostal strain, or even thoracic disc referral. While these definitely will be seen in the clinic, they are not exclusive. The patient that inspired me to write this post described their pain as around the pectoral region but wrapping under the arm as well. This description led me to two hypotheses. Based on location alone, we should suspect some sort of pec major or minor pain. However, these muscles rarely will be the primary pain source.
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