Chest Wall

Chest Wall Injury

  • If a mechanism or pattern:
    • When did it happen?
    • What happened exactly?  Try to understand the mechanism and forces involved (if present)
    • What symptoms initially?
      • Where were the symptoms initially?
      • Describe pain – sharp / superficial / deep / ache / burning etc
      • What aggravates and what eases?
      • Pain on breathing / coughing?
      • Haemoptysis?
    • What symptoms now?
      • Have the symptoms changed? Better / Worse? Location?
  • If no mechanism
    • How long has it been there?
    • Is there anything that they believe may have contributed to the development of the problem? Recent activity / inactivity
    • What symptoms are present?
    • Are they there all the time?
  • What treatment has been sought so far?
    • Assessment
    • Investigations
      • If imaging, do they have it with them?
      • If not, can we view it?
        • Private providers use online applications
        • If in another public hospital in Victoria, then can use the “Synapse Mix” service to get the images temporarily put on local network diagnostic imaging servers.
  • What management has been undertaken? Has it been effective
    • Ice
    • Medications
  • History of problems in that area before
    • When?
    • How was it managed?
      • Assessment undertaken?
      • Investigations
      • Medications
    • Any ongoing problems?
  • Any associated symptoms (if a non mechanical cause or if at all suspicious)
    • Recent illness / fevers / sweats
    • Recent overseas / long haul travel / immobilisation (eg for suspected DVT)
    • Loss of appetite / loss of weight, etc
  • If potentially needing procedural sedation or surgery (and consider this for anyone you are contemplating an x-ray for)
    • Fasting status (and tell them not to eat and drink until you tell them it is ok to do so
  • Observations
    • SaO2, HR, BP
  • Auscultation
  • Thoracic Movement
    • Flexion / Extension
    • Rotation
    • Lateral Flexion
    • Breathing
  • Palpation
    • Thoracic spine
    • Ribs
    • Costovertebral joints
    • Costochondral joints
    • Sternum
  • Special Tests
    • Chest wall springing / compression
  • Imaging
    • If substantial chest wall pain, consider Chest inspiratory / expiratory x-ray to:
      • Exclude Pneuomothorax / Haemothorax
      • Examine the ribs (although rib fractures are often radiologically occult)
    • Also consider thoracic spine involvement
      • May need thoracic spine x-ray as well