How do you describe chest wall tenderness with palpitations in medical terms?

Professional Documentation of Chest Wall Tenderness with Palpitation

Chest wall tenderness with point tenderness on palpation should be documented as "reproducible chest wall tenderness" or "costochondral tenderness" to distinguish it from cardiac causes of chest pain. 1

Proper Medical Documentation Approach

Descriptive Terminology

• Use specific anatomical terms to localize the tenderness:
  • "Reproducible tenderness at the left 4th and 5th costochondral junctions"
  • "Point tenderness over the left parasternal region at the 3rd intercostal space"
  • "Focal chest wall tenderness with pain reproduction on palpation"

Key Examination Findings to Document

• Pain characteristics:
  • Location: Specific costochondral junction or intercostal space
  • Quality: Sharp, stabbing, or stinging (suggests noncardiac origin) 1
  • Reproducibility: "Pain reproduced with direct palpation of the affected area"
  • Modifying factors: "Pain exacerbated by movement, deep inspiration, or positional changes"

Distinguishing Features from Cardiac Pain

• Document findings that suggest musculoskeletal origin:
  • "Pain localized to a specific point with fingertip precision" 1
  • "Pain reproduced with chest wall movement or palpation" 1
  • "Sharp or stabbing quality that increases with respiration" 1
  • "Tenderness confined to costochondral junctions without radiation" 2

Clinical Significance

Diagnostic Implications

• According to the 2021 AHA/ACC guidelines, point tenderness on palpation renders ischemia less likely 1
• Document absence of concerning cardiac features:
  • "No associated dyspnea, diaphoresis, or radiation to jaw/arm"
  • "Pain not precipitated by exertion or emotional stress"
  • "No relief with nitroglycerin administration"

Diagnostic Pearls

• The 2021 AHA/ACC guidelines recommend avoiding the term "atypical chest pain" as it can be misinterpreted as benign 1
• Instead, document as "noncardiac chest pain with reproducible chest wall tenderness" 1
• Include a simple four-point assessment when applicable: "Pain exhibits localized muscle tension, stinging quality, reproducibility with palpation, and absence of cough" 3

Common Pitfalls to Avoid

• Do not assume chest wall tenderness excludes cardiac disease in high-risk patients

  • In adults >35 years, 3-6% of patients with chest wall tenderness may still have underlying coronary artery disease 2
  • Document: "Chest wall tenderness present, but cardiac workup completed due to patient's risk factors"

• Avoid documenting only "chest wall pain" without specific descriptors

  • Instead use: "Localized, reproducible tenderness at the left 4th costochondral junction consistent with costochondritis"

• Remember that palpitations accompanying chest wall pain may require separate evaluation

  • Document: "Chest wall tenderness present with patient-reported palpitations. Cardiac monitoring shows normal sinus rhythm."

By documenting chest wall tenderness with specific anatomical location, reproducibility on examination, and distinguishing features from cardiac pain, you provide clear medical documentation that helps distinguish musculoskeletal causes from more serious cardiac conditions.