EC Orthopaedics

Anterior chest wall syndrome (CWS) is a frequently encountered cause of chest pain in both acute and non-acute medical settings. In the acute context, clinical priorities appropriately focus on excluding potentially life-threatening cardiovascular and pulmonary conditions, particularly acute coronary syndromes. Once these diagnoses are excluded, alternative causes of anterior chest pain must be considered.

Musculoskeletal disorders represent the most common non-cardiac cause of anterior chest wall pain. Less frequent non- musculoskeletal causes, such as gastro-oesophageal reflux disease, may also contribute but are comparatively uncommon. Pathology affecting the sternum and costochondral articulations is a recognised source of symptoms, and a range of nomenclature has historically been applied to these conditions. Tietze syndrome, first described over a century ago, represents a distinct clinical entity within this spectrum, typically involving unilateral pain and tenderness at the second and third costochondral junctions. In sporting populations, CWS is particularly prevalent, especially in bat- and ball-based sports where repetitive upper-limb, trunk rotation, and rib-cage loading occur. The condition frequently follows a relapsing course, attributed to ongoing mechanical stress and hypersensitisation of musculoskeletal and neural structures.

The diagnosis of musculoskeletal anterior chest wall syndrome is primarily clinical, based on history and physical examination. Radiological investigations frequently fail to identify the underlying pathology and are mainly useful in excluding alternative diagnoses. Although generally benign and self-limiting, accurate recognition of ACWS is essential to prevent unnecessary investigations and to guide appropriate activity modification, particularly in athletic individuals.

Keywords: Anterior Chest Wall Syndrome; Tietze Syndrome; Costochondritis; Bat and Ball Sports; Tennis; Activity Modification; Neural Sensitisation

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