Internal Medicine

Chest pain from nerves and adjacent structures

introduction

Chest pain is an increasingly common problem in today's western society that has many causes.
Since most people now do sedentary activities, they tend to adopt a comfortable, but not anatomically correct, back and spinal posture.
As a result, spinal misalignments, vertebral slippage or extremely hardened muscles in the neck and back area are increasingly common.

All of these factors can cause nerves emerging from the spinal cord to compress or become trapped. The result of this can be abnormal sensations, reduced strength, but often also chest pain, which can then often be assigned to a certain area, so-called dermatome-related pain.

Find out more about the topic: Pinched nerve

causes

As a rule, the nerve-related chest pain is based on a pinched or otherwise “irritated” nerve.

Since nerves are used to control the muscles, but also to report sensations of the skin or extremities back to the brain, an irritated nerve can transmit incorrect information, so to speak.
Due to the compression of the nerve, excitations occur here, which are then passed on from the nerve to the brain. Thus, the brain is shown a pain in the chest, which actually has its origin in the nerve.
Depending on the movement of the body or the spine, the compression on the nerves is increased or decreased.

Find out more about the topic at: Nerve pain

Intercostal neuralgia as the cause

Very severe chest pain or pulling in the chest can be caused by what is known as intercostal neuralgia. This is an irritation of the nerve pathways that supply the skin and the muscles between the ribs. The cause is unknown, one suspects mechanical overstress, such as stretching or straining. However, the symptoms usually only appear a little later, so that the patient cannot establish a connection to a dragging event. Some of those affected report very severe pain that they have never had before.

Read more on the topic: Intercostal neuralgia

How do I distinguish intercostal neuralgia from heart attack pain?

The first suspicion is often a heart attack. Burning, stabbing, jerky pain in the chest and on the side of the chest wall is described. The most important difference to a heart attack is the movement-dependent pain.Pain relief can be brought about by correspondingly different positioning. This does not work in the case of a heart attack. Neither do patients with intercostal neuralgia complain of shortness of breath or pressure on the chest. Otherwise, the clinical picture is very similar to a heart attack (sweating, restlessness, fear). Furthermore, there is of course the possibility of a rib bruise or even a rib fracture.

Tietze syndrome as the cause

A so-called Tietze syndrome can also cause severe pain in the chest. The term hides an inflammatory process on the cartilage between the ribs and the base of the breastbone. Here, too, the similarities of a heart attack are present, but here too the pain can be provoked depending on the movement. Another distinguishing feature is the fact that in Tietze syndrome the pain can also be exerted by applying pressure to the corresponding point on the sternum.

You can find out more about this topic under our topic: Tietze syndrome

Pleurisy as the cause

The so-called pleurisy (pleurisy), which is mostly infectious, can also cause severe chest pain. Characteristic are sharp, often very strong but breath-dependent pain that can rule out a heart attack. The duration of pleurisy can be very variable.
Pulmonary embolism, which also causes similar symptoms, should be considered as a differential diagnosis.

Concomitant symptoms

The accompanying symptoms can vary widely.
Nevertheless, the pain is almost always accompanied by sensitive disorders or failures, depending on what exactly is the cause of the entrapment.

Less strength can also be reduced in a specific muscle.
In contrast to the fulminant herniated disc, this loss of strength is hardly noticeable.

In addition, abnormal sensations in the form of tingling or light stinging can rarely occur. All of these symptoms can, however, need not appear in every pinched nerve.

diagnosis

As a rule, the area in which the pain has spread provides a very clear indication.
If the pain area indicated by the patient can be assigned to a so-called dermatome, i.e. runs roughly along the ribs, this substantiates the suspicion that it is a matter of damage or pinching of a nerve that emerges directly from the spinal cord.

An MRI or, in exceptional cases, a CT examination can provide reliable confirmation - provided it is an entrapment caused by a slipped disc.

Read more about MRI at: Procedure of an MRI

treatment

Depending on the type of entrapment, it must be treated differently. As already indicated, most of the problems in modern Western society are due to poor posture or incorrect or insufficient spinal strain, which is why in most cases conservative measures can be treated.

Physiotherapy, which should be continued at home, is usually the method of choice here.

In addition, physical therapy can also be used.
If the entrapment is actually a herniated disc, conservative therapy is preferred first. If this results in a sufficient improvement, you can leave it at that. If this is not the case or if the pain gradually returns, surgical removal of the leaked disc nucleus may be indicated.

Find out more about this topic at: Herniated Disc - What To Do?

If the problem is a narrowed nerve exit hole, it must be surgically enlarged. If, on the other hand, the cause is slipping of the vertebrae, stiffening of the affected spinal column segments may be indicated.

Home remedies for chest pain

As a tried and tested home remedy, the use of a warmth or grain pillow is recommended in most cases.
If a muscle tension or a kind of strain is caused by a pinched nerve, the application of heat can loosen the muscles and thereby loosen the pinching.

But careful physiotherapy can also help to alleviate the pain by correcting the poor posture and stretching any shortened muscle areas again.

forecast

A prognosis of the healing time is difficult and depends to a large extent on the underlying disease and its treatment.

While a simple "vertebral blockage" usually fixes the problem almost in the twinkling of an eye through manual therapeutic treatment, the treatment of a herniated disc can sometimes take years before pain is finally achieved.