Differential Diagnosis for Left Chest Tenderness
Single Most Likely Diagnosis
- Costochondritis: This condition, characterized by inflammation of the cartilage that connects the ribs to the sternum, is a common cause of chest pain and tenderness, especially with movement such as flexion and extension. The location just below the sternum is consistent with costochondritis, particularly affecting the lower costal cartilages.
Other Likely Diagnoses
- Musculoskeletal strain: Given the exacerbation of pain with flexion and extension, a musculoskeletal strain or injury in the chest wall could be a plausible explanation. This could involve the intercostal muscles or the muscles of the chest wall.
- Gastroesophageal reflux disease (GERD): GERD can cause chest pain that may be exacerbated by movement or position changes. The pain is often described as burning and can be located in the lower chest.
- Somatic dysfunction: This refers to impaired or altered function of related components of the somatic (body framework) system, including joints, muscles, and fascia. It could cause localized pain and tenderness, especially with movement.
Do Not Miss Diagnoses
- Myocardial infarction (MI) or acute coronary syndrome: Although less likely given the specific location and nature of the pain, it's crucial to consider cardiac causes of chest pain, especially if there are risk factors or associated symptoms like shortness of breath, arm pain, or jaw pain.
- Pulmonary embolism (PE): This is another critical diagnosis to consider, especially if there's a history of recent travel, immobilization, or other risk factors for thromboembolism. However, the pain pattern described is less typical for PE.
- Pneumonia or pleuritis: Infection or inflammation of the lung or pleura can cause chest pain that worsens with deep breathing or movement. While the location and nature of the pain might not be the best fit, these conditions are important to rule out.
Rare Diagnoses
- Multiple sclerosis (MS) flare: While MS can cause a wide range of symptoms due to its effects on the central nervous system, it is less likely to cause localized chest tenderness to palpation just below the sternum that worsens with flexion and extension. MS-related pain is more commonly neuropathic or related to spasticity.
- Tietze's syndrome: This is a rare condition characterized by inflammation of the cartilages and surrounding tissues of the chest wall, similar to costochondritis but often involving the upper cartilages. It could be considered if costochondritis is ruled out or if the pain pattern doesn't fully match.
- Slipping rib syndrome: This involves the hypermobility of the lower ribs, which can cause chest pain, especially with movement. It's a less common condition but could be considered if other diagnoses are excluded.