MSK/Costocondritis/Tietze Syndrome case

Question 1

What differential diagnoses do you need to rule out first before you consider MSK causes

Answer 1

ACS
Pericarditis
Aortic aneurysm
PE
Pneumothorax

GERD
Rib #

Question 2

What is Tietze syndrome

What rheumatological conditions could also be characterized by costochondritis

Answer 2

Rare inflammatory disorder

• Swelling of costocondral cartilage => pain
• pain can spread to arms, shoulders

Fibromyalgia
RA
PA
AS

Question 3

What investigations would you order

What may you find

Answer 3

CXR
-normal

ECG
-normal

TnT
-no rise

D dimer
-4 points or less, rule out PE

Question 4

What examinations would you order

what may you find

Answer 4

CV
-chest pain is reproducible on palpation over musculoskeletal structures

Resp
-increased RR <= panic, anxiety

Question 5

How would you interpret the results of the Wells score

Where would you go from there

Answer 5

4 or less

• PE unlikely
• If PE is still suspected => screen for thromboembolism
• If +ve => immediate CTPA, anticoagulation in the interim

4+
-immediate CTPA, interim anticoagulation

Question 6

What are the characteristics of MSK chest pain

-SOCRATES

Answer 6

Sharp or dull ache
Pain localised to affected region
May radiate to arms, around chest, back

Exacerbated by pressing on affected area, moving neck

Joints may be affected but patient looks generally well