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19 Cards in this Set
- Front
- Back
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Myocardial Infarction
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Tension/sitting on chest felt in the chest or between shoulder blades.
May radiate to the arms, neck, torso or jaw. Pain may be slightly eased by flexing shoulders. Worsened by deep inspiration Diaphoresis, dyspnea, loss of consciousness, pallor, tachycardia. |
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Tietze's Syndrome |
Sudden/Gradual onset of achy pain in the upper anterior thorax - centrally or parasternally that may radiate to the shoulder/arm. Bulbous swelling of sternocostal joint. Sometimes worsens to a sharp/stabbing pain with activity, sneezing, coughing and deep inspiration. Middle ribs most commonly affected. >40yrs mc.
Tenderness and restrictions of the costal junction of ribs (2-5)
Management: NSAIDS for inflammation Manipulation (not for inflamed site) Exercise/stretches Modalities Activity modification |
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Costochondritis |
Sudden/Gradual onset of achy pain in the upper anterior thorax - centrally or parasternally that may radiate to the shoulder/arm. Sometimes worsens to a sharp/stabbing pain with activity, sneezing, coughing and deep inspiration. Middle ribs most commonly affected. >40yrs mc.
Tenderness and restrictions of the costal junction of ribs (2-5)
Management: NSAIDS for inflammation Manipulation (not for inflamed site) Exercise/stretches Modalities Activity modification |
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Thoracic Disc Herneation |
Prior existing back pain (long hx of discomfort) then a movement/activity caused symptoms to appear. Incident usually precedes sharp pain Pain starts at the back and refers anteriorly Aggravated by: spinal movement, cough/sneeze Sensory changes may mean a burning sensation.
Management: Activity modification Inflammation control Once inflammation settles, address restrictions. Flexion distraction (possibly) |
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Rib fracture |
Blunt traumatic MOI (except pathological fracture) Chest wall pain
Management: kinesiotape Minimise movement If multiple fractures suspected - refer for a medical evaluation. |
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Anxiety |
Can produce MI type symptoms Sharp, intermittent, or stabbing pain that is localised to the left breast Area of pain usually not larger than the tip of a finger but can be as large and teh palm of a hand. Often associated with hyperaesthesia of the cest wall. Pain is not reproduced by palpation or activity, not altered by change in position.
Sinus tachycardia, fatigue, fear of closed-in places, diaphoresis, dyspnea, dizziness, choking sensation, hyperventilation - numbness and tingling of hands and lips.
Management: Behavioral therapy, medication, or some combination of the two. Sometimes complementary or alternative treatments may also be helpful. |
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Thoracic Outlet Syndrome |
Swelling/puffiness in the arm/hand Feeling of heaviness in arm/hand Deep, boring toothache like pain in he neck and shoulder (can be throbbing) Symptoms increase at night Hand and arm easily fatigues Parasthesias - medial forearm and hand (palm) Difficulty gripping Cramps of the muscles of the medial forearm Arm and hand pain
Examination: ROOS, Wrights hyperabduction, Adson's and Halstead - these tests must reproduce the symptoms and diminish the pulse.
Management: Joint manipulations, first rib manipulation/mobilisation, exercises/stretches - lengthen shortened and strengthen weakened, correct abberant biomechanics, modalities, NSAIDS. |
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GORD |
Dull ache in the anterior chest near lower sternum Pain can radiate and simulate an MI Aggravated by bending foreward/lying down Heart burn, regurgitation, dysphagia, bloating, halistosis.
Management: Refer for medical evaluation Advice - avoid aggravating foods/alcohol/tomato/fatty foods, reduce coffee/tea consumption, avoid gasseous drinks, small meal sizes, don't eat 3 hours before bed, elevate head 0-20 degrees at night, avoid NSAIDS. |
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Angina |
Stable: Chronic coronary artery disease (clinical syndrome), transient myocardial ischaemia. Caused by exertion, emotional change. Relieved by rest.
Unstable: Acute coronary syndrome Occurs at rest (or with minimal exertion), usually lasting >10 minutes. Severe and of new onset (within 4-6 weeks) Occurs with a crescendo pattern (distinctly more severe, prolonged, or frequent than previously) |
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Cancer Origin |
Chest, neck, shoulder and/or upper back pain Previous history of cancer Pleural pain Dyspnea Persistent cough |
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Aortic dissection |
Dyspnea upon exertion Pulsatile abdominal mass, abdominal pain, and abdominal rigidity.
Thoracic - hoarsness, wheezing, coughing, hemoptysis, chest pain, back pain, or abdominal pain.
May be asymptomatic.
Patients suspected of AA - refer immediately. |
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Pericarditis |
Substernal pain that may radiate to the neck, upper back, upper trap, left supraclavicular area, left arm, costal margin. Pain relieved by leaning forward/sitting upright. Pain reduced while holding breath Pain aggravated by movement of deep breathing (cough, laugh, deep inspiration and laying down) Lower extremity oedema. |
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Xiphoidynia |
Painful xiphoid process - palpation reproduces pain. Worsens with activity than increases intra-thoracic pressure. Can present as substernal pain, that may radiate to parasternal region.
Management: NSAIDS Corticosteroid injection possible |
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Trigger Points that refer to the Chest. |
Anterior chest: Pec major and minor, Scaleni, SCM, Sternalis, Iliocostalis cervicis, Subclavius, External Abdominal Oblique
Lateral chest pain: Serratus Anterior, Latissimus dorsi
Upper abdominal/lower chest pain: Rectus abdominus, abdominal obliques, transverse abdominus |
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Shingles/Herpes Zoster |
Burning interscapular pain. May be preceeded by itching. Wraps around one side of the thorax to the anterior chest May include: hyperaesthesia, paraesthesia, dysaesthesia Red vescicles appear after 2-3 days (very painful) May last up to 3 weeks Can burst leaving a crust
Management plan: refer to GP ASAP Antiviral medications within 3 days is the most effective treatment >3 days treatment is aimed at pain control |
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Pleurisy |
Sharp, stabbing pain in anterior/lateral chest Constant or intermittent Aggravated by deep inspiration/movements May be tender to palpate chest wall +/- fever
Management: refer for medical evaluation |
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Pneumothorax |
Sudden, sharp unilateral chest pain (anterior or lateral) Worsened with deep inspiration Shortness of breath Tachypnea, tachycardia, hypotension Tracheal deviation contralaterally Absent breath sounds |
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Pulmonary Embolism |
Chest and throat pain Dyspnea Worsened by thoracic spine movements and deep breathing Tachycardia, cough, fever, cyanosis, clubbing Local tenderness |
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Myocardial Infarction |
Tension/sitting on chest felt in the chest or between shoulder blades. May radiate to the arms, neck, torso or jaw. Pain may be slightly eased by flexing shoulders. Worsened by deep inspiration Diaphoresis, dyspnea, loss of consciousness, pallor, tachycardia. |
