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Chest pain and discomfort is very common. Usually, if you go to the hospital with chest pain, the doctor will focus on making sure it is not a life-threatening condition such as a heart attack or a clot in your lungs.

The exact origin of a cracking sound of the joints is still a mystery. There are many theories, such as a partial dislocation, air, and nitrogen bubbles being released causing the cracking sound. The cracking would be caused by noise from the joints that are connected to the sternum. These are the sternocostal joints (sternum and ribs), costochondral (ribs and cartilage) joints and the sternoclavicular joints (clavicles to the sternum). Cracking is not usually considered medically significant unless there is inflammation or swelling or the joint.

Musculoskeletal Chest syndromes

Costochondritis - Anterior chest syndrome/Costo sternal syndrome.

This pain is caused at the place your sternum joins with the ribs. The upper joints are the most affected. The affected areas/joints are usually not clinically inflamed (no redness or swelling), but painful when pushed on.

The doctor may do a few manoeuvres to try and reproduce the pain. Most cases are self-limiting and short-lived. Simple oral anti-pain medications or injections into the joints may be used.

Tietze's Syndrome

This is a rare form of musculoskeletal chest pain and is characterized by a painful swelling of the joints that are connected to the sternum. The most common areas affected being upper joints. It usually affects young adults, and usually only one area is involved. The cause is unknown, but there seems to be an association with recent colds and coughs.

Xiphoidalgia

This is also a rare cause of chest pain. In this syndrome, the pain is isolated to the lowest part of the sternum and is worsened by movement. It may be associated with a return to heavy work after a break or recent cough.

Spontaneous Sternoclavicular Subluxation (Partial Dislocation)

This syndrome occurs almost always in women and occurs in the dominant hand that performs repetitive movements.

Relapsing polychondritis

This is very rare and involves inflammation of the cartilage in the body (cartilage bridges the joints between the sternum and the ribs). Many areas of cartilage are usually involved; the nose, ears and breathing tract.

Mechanical Stress

This may be common in people who put reparative heavy loads through these joints such as rowing, bench pressing and throwing that may lead to stress fractures.

Chest pain caused by Rheumatological disease

  1. Rheumatoid arthritis; There may be involvement of the sternoclavicular joint, and this can be seen on ultrasound or x-rays
  2. Ankylosing Spondylitis; this may occur if the spine that supports the chest is involved. The most common symptoms are lower back pain and buttock pain.
  3. Psoriatic arthritis; this is arthritis associated with the skin condition psoriasis. In this type, the joints of the sternum may be involved but infrequently.

Tests

Depending on the syndrome the tests will vary from no test at all to multiple. The basics may include x-rays to more advanced tests such as CT-Scans of the test to try and find out the cause. Blood test may be ordered if a rheumatological disease is suspected.

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