What is the diagnosis for a patient presenting with reproducible tenderness to the left first rib and bruising noted?

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Last updated: April 13, 2025 • View editorial policy

Differential Diagnosis for Reproductive Tenderness to Left First Rib and Burning

  • Single most likely diagnosis + Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, which can cause tenderness and burning sensations. The location of the tenderness to the left first rib is consistent with this diagnosis.
  • Other Likely diagnoses + Musculoskeletal strain: Strain or injury to the muscles or ligaments surrounding the first rib can cause tenderness and burning sensations. + Thoracic outlet syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can cause pain, numbness, and burning sensations in the shoulder and chest area. + Fibromyalgia: A chronic condition characterized by widespread muscle pain, tenderness, and burning sensations, which can be localized to the first rib area.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed) + Pulmonary embolism: Although less likely, a pulmonary embolism can cause sudden onset of chest pain and tenderness, which may be referred to the first rib area. + Aortic dissection: A tear in the aorta can cause severe chest pain, which may radiate to the first rib area, and is a medical emergency. + Pneumothorax: A collapsed lung can cause sudden onset of chest pain and tenderness, which may be referred to the first rib area.
  • Rare diagnoses + Sickle cell crisis: A condition that can cause episodes of severe pain, including chest pain and tenderness, due to sickling of red blood cells. + Neurogenic tumor: A rare tumor that arises from the nerves, which can cause pain, numbness, and burning sensations in the shoulder and chest area. + Osteomyelitis: A rare infection of the bone, which can cause pain, tenderness, and burning sensations in the affected area, including the first rib.

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