Chest wall syndrome among primary care patients: a cohort study François Verdon1, Bernard Burnand2, Lilli Herzig1, Michel Junod1, Alain Pécoud3 and Bernard Favrat*3 Address: 1Institute of General Medicine, University of Lausanne, Lausanne, Switzerland, 2Clinical Epidemiology Centre, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland and 3Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland Email: François Verdon - firstname.lastname@example.org; Bernard Burnand - Bernard.Burnand@chuv.ch; Lilli Herzig - email@example.com; Michel Junod - firstname.lastname@example.org; Alain Pécoud - Alain.Pecoud@hospvd.ch; Bernard Favrat* - Bernard.Favrat@chuv.ch * Corresponding author
Published: 12 September 2007 BMC Family Practice 2007, 8:51 doi:10.1186/1471-2296-8-51
Received: 11 August 2006 Accepted: 12 September 2007
This article is available from: http://www.biomedcentral.com/1471-2296/8/51 © 2007 Verdon et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). Methods: Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results: Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion: CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.
Chest pain is a frequent complaint in ambulatory care, and while well described in emergency settings, it is less well studied in general practice. The causes are diverse,
including a broad spectrum from life threatening diseases to benign causes such as chest wall syndrome (CWS) [1,2]. This painful condition of the anterior chest wall is caused by a musculoskeletal disorder and associated with Page 1 of 7
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tenderness of the chest wall. However, the benignity of this syndrome should be questioned when considering that it can produce for patients, greater impairment in daily activities, emotional distress and a higher level of anxiety than ischemic heart...