Stabbing chest pain right side under breast

1. What is chest wall pain?
2. Symptoms 
3. Diagnosis
4. Treatment 
5. Coping with chest wall pain

1. What is chest wall pain?

Chest wall pain may feel as though it’s coming from the breast, but really it comes from somewhere else. It’s also known as extra-mammary (meaning outside the breast) pain.

Chest wall pain can have a number of causes, including:

• pulling a muscle in your chest 
• inflammation around the ribs, caused by conditions called costochondritis or Tietze's syndrome 
• a medical condition such as angina or gallstones 

Breast pain can have a number of other causes, but on its own is not usually a sign of breast cancer.

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2. Symptoms of chest wall pain

The pain can be on one side, in a specific area or around a wide area of the breast. 

It may be burning or sharp, may spread down the arm and can be worse when you move.

This type of pain can also be felt if pressure is applied to the area on the chest wall.

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3. Diagnosing chest wall pain

See your GP if your breast pain is new and carries on. 

Your GP will examine your breasts and take a history of the type of pain you have and how often it occurs. To check how long the pain lasts for, how severe the pain is or if the pain may be linked to your menstrual cycle, your GP may ask you to fill in a simple pain chart. 

If your GP thinks you may have chest wall pain, they may ask you to lean forward during the examination. This is to help them assess if the pain is inside your breast or in the chest wall. 

Your GP may refer you to a breast clinic where you’ll be seen by specialist doctors or nurses for a more detailed assessment.

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4. Treating chest wall pain 

Treatment for chest wall pain will depend on what’s causing it. 

If it’s found that your breast pain is caused by a pulled muscle in your chest, this is likely to improve over time and can be treated with pain relief. 

Chest wall pain can also affect the area under the arm and towards the front of the chest, and this may be due to: 

• costochondritis – inflammation of parts of the ribs (called costal cartilages) 
• Tietze’s syndrome – inflammation of the costal cartilages and swelling

Your GP or specialist may be able to tell that the costal cartilages are painful if pressure is put on them. Sometimes this inflammation can feel similar to heart (cardiac) pain. You may feel tightness in the chest and a severe, sharp pain. The pain may also spread down the arm and can be worse when you move. 

You may find it helpful to rest and avoid sudden movements that increase the pain. Pain relief such as paracetamol or a non-steroidal anti-inflammatory such as ibuprofen (as a cream, gel or tablet) may help. 

Your specialist may suggest injecting the painful area with a local anaesthetic and steroid. 

Smoking can make the inflammation worse, so you may find that your pain lessens if you cut down or stop altogether.

The NHS website has more information about costochondritis and Tietze’s syndrome.

Pain caused by other medical conditions, such as angina (tightness across the chest) or gallstones, may be felt in the breast. Your GP or specialist will advise you on the most appropriate treatment.

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5. Coping with chest wall pain

Any type of breast pain can be very distressing, and many women worry they may have breast cancer. However, in most cases pain in the breast isn’t a sign of breast cancer.  

Having breast pain doesn’t increase your risk of breast cancer. However, it’s still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts. 

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Heart disease not the only reason for that feeling of angina

Although chest pain is often—and rightfully— associated with heart disease, other medical problems can be causes of chest pain. Angina—feelings of pressure, heaviness, tightness. or pain in the chest—occurs when plaque in the coronary arteries partially blocks blood flow and the heart muscle isn't getting enough oxygen and nutrients. (You can learn more about angina in the Harvard Special Health Report Diseases of the Heart: A compendium of common heart condition and the latest treatments.) Yet the heart isn't the only organ in the upper abdomen, and chest pain may be due to conditions affecting the esophagus, lungs, gall bladder, or stomach.

Digestive causes of chest pain

When chest pain—particularly pain in the lower chest— is triggered by a meal, it is likely to emanate from the digestive system, rather than from the heart, and can be due to the following:

Acid reflux or heartburn. When acid from the stomach flows up into the esophagus, it can cause a burning sensation in the chest reminiscent of a feeling of angina  or often mistaken for a heart attack.

Esophageal spasm.  Sudden, forceful contractions of the esophagus, the muscular tube between the mouth and the stomach, can be painful. These spasms can also trap food in the esophagus and prevent it from passing into the stomach.

Gallbladder disease. A sudden pain that often occurs 30 minutes after you have eaten may be a sign of gallstones. Gallbladder pain is usually felt just below the breastbone and may extend to the right arm or between the shoulder blades. It occurs as the gallbladder contracts in an effort to pump bile around the gallstones that are blocking its passage to the liver.

Inflammatory causes of chest pain

Tissues in the chest cavity can become inflamed due to injury, infection, or autoimmune conditions, in which the body's immune cells attack its own tissues. Common inflammatory causes of chest pain include the following:

Costochondritis. This condition, an inflammation in the chest wall between the ribs and the breastbone, can trigger a stabbing, aching pain that's often mistaken for a heart attack. Costochondritis is commonly caused by trauma or overuse injuries, often during contact sports, or it may accompany arthritis.

Pericarditis is an inflammation of the pericardium, a protective, double-layered sac surrounding the heart. It has many different possible causes, including a virus or other infection, certain illnesses, an injury to the chest, radiation therapy for cancer, or a reaction to medications. The classic symptom of pericarditis is a sharp, stabbing pain in the center or left side of the chest that worsens when you take a deep breath or lie down. The pain results from the irritated layers of the sac rubbing together.

Lung-related causes of chest pain

The following lung conditions often produce chest pain that may feel like angina. 

Pneumonia can cause shortness of breath and sharp pains that intensify with a deep breath. Unlike angina, it is likely to be accompanied by other symptoms, like fever, chills, or coughing.

Pulmonary embolism—a blood clot that has traveled into the vessels supplying the lungs—can cause chest pain. The pain is often accompanied by a fast or irregular heartbeat, sudden difficulty breathing, or feeling lightheaded or faint. Pulmonary embolisms can be life-threatening, so the symptoms warrant a call to 911.

Psychological causes of chest pain

Both anxiety and panic attack can cause symptoms very similar to angina. These attacks—which can occur out of the blue or in response to a stressful event—include chest pain along with shortness of breath, palpitations, and dizziness. The key difference is that the chest pain is usually fleeting, lasting only a moment or two.

What to do when you're uncertain

Any time you're uncertain about the source of chest pain that is recurrent or lasts for several days, you should talk to your clinician. However, if you have chest pain that is building in intensity, has lasted for several minutes, and isn't relieved by resting, you should get immediate medical attention.

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