The various causes of anterior chest wall pain are reviewed with particular reference to the clinical manifestations of coronary artery disease (CAD), costochondritis and the myofascial pain syndrome.
Attention is drawn to the manner in which myofascial pain syndrome in the anterior chest wall may arise as a result of primary trauma or anxiety-induced activation of myofascial trigger point (MTrP) nociceptors and also as a result of the secondary activation of MTrPs situated in a zone of cardiac pain referral, and how myofascial pain syndrome may develop in patients with mitral valve prolapse.
It is explained that, because of an appreciable incidence of concomitant costochondritis and CAD pain and of MTrP and CAD pain, and because dry needling in both myofascial pain syndrome and costochondritis may relieve underlying CAD pain, it is not infrequently necessary in cases of anterior chest wall pain to carry out a detailed cardiological assessment including electrocardiographic exercise testing and radionuclide cineangiography.
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