Sometimes this is obvious, as in the case of acute trauma or injuries including rib fracture or contusion and muscular strains in, for example, pectoral or intercostal muscles. More commonly, general practitioners (GPs) seek to determine the specific cause. As a result, it has been proposed that disorders causing anterior chest wall pain should be grouped as an entity called ‘chest wall syndrome’, 3 but this is not widely accepted and the clinical implications of this approach are unclear. It may be difficult, therefore, to pinpoint the exact source of pain in an individual patient. The chest wall contains a range of bony and soft tissue structures, including the spine. 1 This article focuses on musculoskeletal chest wall pain (MCWP), particularly its causes, assessment and management of the most common causes.

2 By contrast, musculoskeletal conditions were diagnosed in only 6.2% of patients presenting to the hospital emergency department with chest pain 1 but in this setting, serious causes such as cardiovascular disease were far more common. Estimates of their prevalence in the general practice setting range from 20.6% 1 to 46.6%. Although it is critical to rule out potentially life-threatening conditions, in the general practice/primary care setting, musculoskeletal conditions are the most common causes of chest pain. See our articles on Engorged Breasts, Mastitis Symptoms and Treatment and Thrush on Nipples for more information.Chest pain is a common general practice presentation, which, because of its diverse and potentially serious causes, requires careful and often urgent assessment. Photo courtesy Emily Walker Other causes of deep breast painįinding the causes of sore nipples or reasons for pain deep in the breast are not always straightforward-mammary constriction syndrome may only be part of the puzzle. Deep breast pain can be associated with engorgement with breast milk or mastitis and is sometimes confused with thrush. One of these four areas is likely to be the ideal spot for her to relieve her pain. There are four places to massage: 1) above the breast against the chest wall 2) between her breasts just to the side of the breast bone 3) under the breast against her rib cage 4) on the side of her body, beside her breast, against the rib cage. It involves rubbing the chest muscles ( not the breast) quite vigorously for about 45-60 seconds on the affected side. In the excerpt below Dr Newman briefly describes the treatment technique of pectoral muscle massage Excerpt from Mammary Constriction Syndrome, Dr Jack Newman’s Community Page on Facebook, Feb 2014 A poor latch can lead to the secondary problem of vasospasm symptoms of the nipple and mammary constriction syndrome (often mistakenly diagnosed as thrush on nipples as the symptoms are very similar).

Here he describes how most cases of breast pain-and/or nipple pain-in breastfeeding mothers are the result of a poor latch at the breast. There is a useful post online about mammary constriction syndrome on Jack Newman’s Community Facebook page.

Jack Newman is a Canadian paediatrician and breastfeeding author. She also suggests a mother with this syndrome should try to keep her back supported rather than hunching forward over her baby and avoid carrying heavy items such as shopping bags or heavy car seats. This involves massage of the chest muscles to help ease the tension and trying gentle pectoral muscle stretching, just before a breastfeed. Also, if a latch feels painful, the mother may tighten her shoulders, clench her teeth, etc., causing the cycle triggering pain to begin again.Įdith Kernerman recommends treating mammary constriction syndrome with a technique she calls pectoral muscle massage. This pain may be throbbing or constant, deep or superficial, itchy, tingling, aching or knife-like, burning or freezing, shooting, sharp or dull, or a combination of any of the above.

Jack Newman’s Guide to Breastfeeding (updated edition) p146īecause of difficulties the mother may have had during pregnancy, labour, or after birth, she may have tightness in her shoulders and chest that causes her pectoral (chest) muscles to press on the blood vessels that lead to her breasts and nipples, causing a lack of blood flow and oxygen, leading to pain. Tension may have several causes including the way a mother is sitting to breastfeed for long periods or the tensing of her shoulders in anticipation of a very painful latch. Edith Kernerman explains Excerpt from Dr. Tension in a mother’s shoulders or chest can cause her pectoral muscles beneath the glandular tissue in the breast to press on the blood vessels that supply the breast and nipples.

Pain in centre of chest between breasts