Anterior Chest Pain Presentation

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.

The more significant source in this patient's case was the serratus anterior muscles referral pattern. Upon evaluation, scapular winging and downward rotation were noted with positioning and weakness was noted with MMT. Even if the muscle referral pattern was not noted in the evaluation, addressing the impairment of serratus anterior weakness would have been essential. Take a look at the referral pattern as this perfectly matched the patient's pain presentation. While this patient likely would have gotten better simply treating the impairments, being able to address the specific source of the pain was useful for decreasing the patient's pain and improving her disability with a tool like dry needling early on can increase the speed of the patient's recovery

-Chris.

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