Differential Diagnosis for Chest Pain Radiating to the Right Arm, Worsening with Movement

Single Most Likely Diagnosis

• Musculoskeletal Pain: This is often the most common cause of chest pain that radiates to the arm and worsens with movement. Conditions such as costochondritis or musculoskeletal strain can cause this type of pain due to the involvement of the muscles and joints in the chest wall.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the arms and can be exacerbated by movement or position changes. The pain is typically burning in nature and can be associated with symptoms like heartburn.
• Panic Disorder or Anxiety: Panic attacks can cause chest pain or discomfort that may radiate to the arms, and the pain can worsen with movement or deep breathing. Anxiety can also exacerbate or mimic other conditions.
• Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the chest and arm, especially with movement of the arm.

Do Not Miss Diagnoses

• Myocardial Infarction (MI) or Acute Coronary Syndrome: Although less common in a 30-year-old, MI can occur at any age, especially with risk factors like smoking, hypertension, diabetes, or a family history of early heart disease. The pain is typically described as heavy or squeezing and can radiate to the arms.
• Pulmonary Embolism (PE): A blood clot in the lungs can cause sudden onset of chest pain that worsens with deep breathing or movement. Other symptoms may include shortness of breath, cough, or leg swelling.
• Aortic Dissection: This is a tear in the inner layer of the aorta. The pain is often severe and tearing in nature, radiating to the back or arms, and can be exacerbated by movement.

Rare Diagnoses

• Pneumothorax: Air in the pleural space can cause chest pain that worsens with deep breathing or movement. It's less common but can be life-threatening if not recognized.
• Esophageal Spasm or Rupture: Spasm of the esophagus can cause severe chest pain, and rupture (Boerhaave's syndrome) is a rare but serious condition that requires immediate medical attention.
• Tietze's Syndrome: A rare inflammatory condition affecting the cartilages and surrounding tissues of the ribs, causing chest pain that can radiate to the arms and worsen with movement.