Musculoskeletal Chest Wall Pain

During your attendance at the Cambridge Breast Unit you have had a full assessment of your breast pain symptom: this will have consisted of a clinical examination, along with a mammogram if you are over 40. There is no other radiological test that is helpful in assessing breast pain if no other symptoms are present. Following this assessment, you have been reassured there is no underlying breast problem causing your pain and have been advised that the pain you are experiencing is musculoskeletal chest wall pain.

What is musculoskeletal chest wall pain?

Musculoskeletal chest wall pain is the commonest cause of breast pain, and one of the most frequent reasons for patients attending the breast unit. The pain is often described as burning, shooting, or sharp and can often be felt deep in the breast. It can also be associated with a deep itching sensation which is not relieved by scratching. Sometimes it is described as feeling like a pulled muscle.

The pain is often felt within the breast: it can shoot up from below the breast, up through the nipple, across the top of the breast or sometimes up under the arm/into the upper inner arm. However, it is actually arising from the soft tissues of the chest wall rather than from the breast itself.

When being assessed in the clinic, you may have felt a sharp pain when pressure was applied to the chest wall; this may feel very much like the pain you have been experiencing and is very common in chest wall pain.

What causes musculoskeletal chest wall pain?

Chest wall pain can be triggered by many different activities. Common causes are recent changes in activity or exercise levels, gardening, heavy lifting or any strain to the arms. It can also occur as a result of prolonged, repetitive work at a computer. Pain can also arise as a result of inflammation around the ribs caused by conditions such as Costochondritis or Tietze’s syndrome. However, sometimes there is no obvious reason for the pain.

There is an association with some other conditions too. Pre-existing problems such as arthritis, thinning of the bones (osteopenia and osteoporosis) or rib fractures following trauma can increase the chance of developing chest wall pain. It can also be more common in those who have had surgery or radiotherapy treatment for breast cancer.

What can I do to help the pain?

• Try to identify and avoid any precipitating activity
• Continue with gentle exercise and stretching; consider seeking physiotherapy advice to guide this
• If you work at a computer, arrange a review your work station to ensure it is ergonomic
• Avoid prolonged periods of sitting – take a break and walk around for 5mins every hour
• Ensure you are wearing a well-fitting bra and consider a lightweight bra at night
• Avoid smoking as this can often make symptoms worse

Recommended Treatments:

A non-steroidal anti-inflammatory (NSAID) such as ibuprofen can provide effective relief. It is particularly effective as a gel rubbed into the painful area. Paracetamol can also provide some relief.

Vitamin D supplements can be beneficial for chest wall pain. Daily supplements, particularly in the winter months can be helpful. Aim for 400-800 IU (international units) daily, although those who are found to be deficient in vitamin D on a blood test may require higher doses.

How long will the pain last?

Generally, chest wall pain will go away of its own accord. However, it can sometimes take several months to settle.

If your pain does not improve with the recommendations above, or the pain changes in any way, please return to your GP to discuss further help.