What is the treatment for anterior chest wall muscle strain?

Treatment of Anterior Chest Wall Muscle Strain

The first-line treatment for anterior chest wall muscle strain is rest, ice, compression, and NSAIDs for pain management, followed by gradual rehabilitation with stretching and strengthening exercises as symptoms improve. 1

Initial Management (Acute Phase: 0-72 hours)

Pain Management

• NSAIDs: Use maximum tolerated and approved dosage for pain relief 2
  • Evaluate response after 2-4 weeks
  • Consider NSAID rotation if insufficient response
• Muscle Relaxants: Cyclobenzaprine can be used as an adjunct to rest and physical therapy for relief of muscle spasm for short periods (up to 2-3 weeks) 3

RICE Protocol

• Rest: Limit activities that cause pain to prevent further injury
• Ice: Apply ice for 15-20 minutes every 2-3 hours to reduce inflammation
• Compression: Use elastic bandage to provide support and reduce swelling
• Elevation: When possible, elevate the affected area to reduce swelling

Rehabilitation Phase (After Acute Pain Subsides)

Early Mobilization

• Begin gentle range of motion exercises as soon as pain allows
• Early mobilization is crucial to prevent adhesions and minimize inactivity-induced atrophy 4
• The optimal length of immobilization depends on injury severity but should not be longer than needed for healing

Physical Therapy

• Implement a graduated rehabilitation program focusing on:
  • Stretching to restore flexibility
  • Progressive strengthening exercises for chest and shoulder muscles
  • Scapulothoracic and core strengthening 5
• Duration typically 2-4 weeks depending on severity

Special Considerations

Diagnostic Imaging

• MRI is recommended only when radiologic evaluation is necessary for diagnosis 1
• For persistent or severe pain, MRI can detect extent of soft tissue and osseous involvement that may not be apparent on CT 2

When to Suspect Complications

• Be aware of neurovascular complications in patients with anterior chest wall involvement 2
• If pain persists beyond expected recovery time (2-3 weeks), consider:
  • More severe injury than initially diagnosed
  • Underlying pathology such as costochondritis or other musculoskeletal disorders 6

Return to Activity

• Gradual return to normal activities as pain subsides
• Complete recovery is expected in most cases with proper management 1
• Athletes can typically return to play after a conservative management period 5

Differential Diagnosis Considerations

• Musculoskeletal chest wall pain is often mistaken for more serious conditions like angina pectoris or pleurisy 6
• Common musculoskeletal causes of anterior chest pain include:
  • Costochondritis
  • Traumatic muscle pain
  • Referred pain
  • Arthritis involving articulations of the sternum and ribs 6

The prognosis for anterior chest wall muscle strain is generally excellent with appropriate conservative management. Most patients recover fully within 2-3 weeks when following the recommended treatment protocol of initial rest and pain management followed by progressive rehabilitation.