Pain in chest from back
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Understanding Chest Pain Radiating from the Back: Causes and Diagnostic Insights
Spondyloarthritis and Anterior Chest Wall Pain
Spondyloarthritis (SpA) is a significant cause of chest pain radiating from the back, particularly in patients with inflammatory back pain (IBP). Research from the DESIR cohort highlights that anterior chest wall (ACW) pain is prevalent in 44.6% of patients with early IBP suggestive of SpA. This pain is often associated with enthesitis, thoracic spine involvement, and radiographic abnormalities of the sacroiliac joints, indicating a more severe disease course. The presence of ACW pain can be a diagnostic feature for ankylosing spondylitis (AS).
Aortic Dissection: A Critical Emergency
Aortic dissection is a life-threatening condition that presents with severe chest pain radiating to the back. It is more common in men aged 55-65 and requires urgent medical attention. Symptoms can include sudden onset chest pain, changes in consciousness, and absent pulses in the limbs. Imaging, such as a computed tomogram, is crucial for diagnosis. Another case study describes a patient with similar symptoms, emphasizing the importance of recognizing this condition promptly.
Acute Aortic Syndrome and Differential Diagnosis
Acute aortic syndrome can mimic other conditions like acute coronary syndrome and pulmonary embolism, but it requires different management strategies. Patients may present with pleuritic chest pain and normal initial cardiac investigations, making differential diagnosis challenging. This underscores the need for comprehensive diagnostic approaches to distinguish between these conditions.
Musculoskeletal Causes: Scalenus Medius Muscle Spasm
Musculoskeletal issues, such as spasms in the scalenus medius muscle, can also cause chest and back pain. This muscle spasm can lead to hyperactivity of the dorsal scapular or long thoracic nerves, resulting in pain in the rhomboid or serratus anterior muscles. Treatments like trigger point injections, physical therapy, and NSAIDs can be effective.
Thoracalgia and Multidisciplinary Approach
Thoracalgia, or chest pain, is a common issue encountered by various healthcare professionals, including neurologists, rheumatologists, and primary care physicians. It often involves muscle tension in the back and neck and can be mistaken for other serious conditions. A multidisciplinary approach is essential for accurate diagnosis and treatment.
Straight Back Syndrome
Straight back syndrome is a less recognized cause of chest and back pain. It involves a loss of the normal thoracic kyphosis, leading to symptoms like chest pain, palpitations, and dyspnea. Chiropractic therapy has been shown to alleviate symptoms effectively.
Conclusion
Chest pain radiating from the back can stem from various causes, including inflammatory conditions like spondyloarthritis, life-threatening emergencies like aortic dissection, musculoskeletal issues, and structural abnormalities like straight back syndrome. Accurate diagnosis often requires a combination of clinical evaluation, imaging, and a multidisciplinary approach to ensure appropriate management and treatment.
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