What causes solar plexus tenderness upon palpation?

Causes of Solar Plexus Tenderness Upon Palpation

Solar plexus tenderness upon palpation is most commonly caused by musculoskeletal disorders, abdominal neurosis (celiac/solar plexus syndrome), or referred pain from visceral structures. 1

Primary Causes

1. Musculoskeletal Causes

• Costochondritis/Tietze syndrome: Characterized by tenderness of costochondral joints in the anterior chest wall 2
• Myofascial trigger points: Can cause both local and referred pain when palpated 3
• Trauma: Direct injury to the epigastric region

2. Neurogenic Causes

• Celiac/Solar Plexus Syndrome: A specific type of abdominal neurosis characterized by:
  • Epigastric pain
  • "Lambda-type" tenderness in the solar plexus region
  • Pain arising from the periaortic nervous plexuses 1
• Neuropathic pain: Can develop after surgeries, infections, or idiopathically 2

3. Visceral Causes (Referred Pain)

• Pancreatic disorders: Chronic pancreatitis or pancreatic cancer can cause pain transmitted through the celiac plexus 4, 5
• Liver, spleen, or gastric disorders: Can refer pain to the epigastric region 4
• Pleuritic conditions: Pleural irritation can sometimes cause chest wall tenderness that mimics musculoskeletal pain 6

Diagnostic Approach

Physical Examination

1. Focused cardiovascular examination:

   • Assess for signs of acute coronary syndrome or other serious causes of chest/epigastric pain 2
   • Look for diaphoresis, tachypnea, tachycardia, hypotension, or abnormal heart sounds

2. Abdominal examination:

   • Evaluate for epigastric tenderness, guarding, or rebound tenderness
   • Assess for hepatomegaly, splenomegaly, or abdominal masses

3. Musculoskeletal assessment:

   • Palpate costochondral junctions for tenderness 2
   • Assess for myofascial trigger points that reproduce the patient's pain 3
   • Evaluate for pain with respiratory movements

4. Neurological examination:

   • Test for dermatomal distribution of symptoms (radiculopathy) versus multiple peripheral nerve distributions (plexopathy) 7
   • Assess for cutaneous allodynia or hyperalgesia in the epigastric region

Diagnostic Testing

For persistent or concerning solar plexus tenderness:

1. Laboratory studies:

   • Complete blood count
   • Metabolic panel including liver and pancreatic enzymes

2. Imaging:

   • MRI: Most appropriate for suspected plexopathy 2, 7
   • CT scan: Useful for evaluating the celiac plexus region and surrounding structures 5
   • Ultrasound: May be useful as a supplemental test in selected cases 2

3. Special tests:

   • Anesthetic challenge test: If pain improves after local anesthetic, suggests peripheral/nociceptive component 2
   • Electrodiagnostic studies: To confirm diagnosis and determine extent of nerve damage if plexopathy is suspected 7

Management Considerations

For Musculoskeletal Causes

• Rest and activity modification
• Anti-inflammatory medications
• Physical therapy
• Heat or ice application

For Neurogenic Causes

• For peripheral neuropathic pain: Topical nerve regenerative therapies 2
• For central component: Oral neuromodulators (pregabalin, gabapentin, duloxetine, amitriptyline) 2
• For refractory cases: Consider celiac plexus block for diagnostic and therapeutic purposes 4, 5

For Visceral Causes

• Treat the underlying condition
• Pain management strategies including medications and interventional approaches

Important Caveats

1. Beware of misdiagnosis: Solar plexus tenderness is often misinterpreted as a painful condition of abdominal or retroperitoneal origin 1

2. Rule out serious conditions: Life-threatening causes of epigastric/chest pain must be excluded, including acute coronary syndrome, pulmonary embolism, aortic dissection, and esophageal rupture 2

3. Consider referred pain: Tenderness on palpation does not always indicate a primary musculoskeletal disorder; it can be a manifestation of referred pain from visceral structures 6

4. Psychological factors: Anxiety and depression often coexist with chronic pain conditions and may exacerbate symptoms 2