The bones of the thoracic cavity are part of the outer chest wall with the sternum, clavicle and ribs in the front (anterior), ribs on the sides (lateral) and ribs and vertebrae at the back (posterior). The scapula may also be considered as part of the chest wall as any pathology within this bone may also cause bone chest pain.
Causes of Bone Chest Pain
Pain arising from the bones or joints may cause chest pain that will often elicit tenderness to touch or firm pressure. The pain usually aggravates with breathing or movement and may ease when at rest.
The most common causes of bone or joint chest pain include :
Fractures of the bones of the thoracic cavity (sternum, ribs, clavicle or vertebrae) will cause chest pain that can be felt in the bone or referred to surrounding areas. A fracture is most often caused by severe force (trauma) although even slight force can result in a fracture in patients with osteoporosis. A fracture (broken bone) may be complete, where the bone has separated or incomplete where the bone is still connected (‘bone crack’). The latter is more likely in a fracture of a vertera (spine bone) or sternum (breastbone).
There is usually swelling, redness and pain visible at the point of the fracture as well as of the surrounding soft tissue. The pain usually aggravates with movement or breathing.
Costochondritis which is the inflammation of the cartilage and joints between the ribs and sternum (breast bone). It can vary in intensity from a dull ache to a sharp pain and is one of the main causes of breastbone pain. There are a number of causes of costochondritis with trauma, excessive pressure on the ribcage (internal like when sneezing or coughing forcefully and external like when sleeping on the chest on a hard surface), abnormal body movements and weight bearing exercises being among the main causes. Fibromyalgia, infection and respiratory illnesses may also be responsible for costochondritis.
Apart from pain and/or tenderness at the costosternal joint, there may also be visible or palpable swelling, pain when taking deep breaths or coughing. In severe cases, it can cause a difficulty breathing due to pain upon inspiration (inhaling). Costochondritis may lead to a sublaxation (dislocation) of the joint and some patients may stretch their arms and report a ‘clicking’ or ‘popping’ sound which relieves the pain at times.
Osteoporosis is degenerative bone condition where the density of the bone gradually decreases thereby causing weak and fragile bones. There may be many major and minor fractures that will occur over years, some of which may not even be noticed.
Bone pain is not a common symptom of osteoporosis unless there is a fracture.
Osteoarthritis occurs when the cartilagenous ends of a bone wears down and bones surfaces make contact with each other. While it is not common in the ribs, breastbone or thoracic and cervical (chest) vertebrae, it is nevertheless a possibility. Rheumatoid arthritis is a type of autoimmune disease where there is painful joint swelling. Similar to osteoarthritis, the joints of the bones that make up the thoracic cavity are not a common site for rheumatoid arthritis but it is possible.
Joint swelling and pain are the most marked signs of arthritis of the bones and joints of the chest cavity.
Bone or joint infections do not usually occur as primary infections. Usually an infection from elsewhere in the body spreads to the bone (osteomyelitis) causing bone pain, tenderness, fever and weight loss. These infections are usually due to bacteria although some fungi may also cause bone infections.
Tuberculosis (TB) of the bone and joint(s) usually occurs secondary to TB of the lung (pulmonary TB) and is caused by the bacteria, Mycobacterium tuberculosis. When this bacterial infection affects the bones of the thoracic cavity, it is more likely to affect the vertebrae (Pott’s disease).
The respiratory symptoms of TB are most noticeable and these include persistent coughing which may at times be a bloody cough, fever and night sweats, difficulty breathing and weight loss. It is more likely to cause lung chest pain although pain may be felt within the bones or joints once the infection spreads to these sites (miliary TB).