Differential Diagnosis in PT, P-09: Screening for Systemic Disease - Chest and Breast (U)


When our patients are faced with chest pain, we must know how to assess the situation quickly and decide if medical referral is required…and whether medical attention is needed immediately! 

Angina, anxiety, upper gastrointestinal disease and pulmonary conditions are only a few examples of systemic diseases that can cause chest and/or breast pain. Various NMS conditions such as thoracic outlet syndrome, costochondritis, trigger points and cervical spine disorders can also affect the chest and breast. We must be able to differentiate NMS from systemic origins of symptoms.  

The overall course will introduce students and clinicians to the role that health screenings and review of systems play in the clinical decision-making leading to a physical therapy diagnosis. 

This course is designed for physical therapists working with clients in all settings and at all levels from beginner to advanced. This section will review symptoms or other signs suggesting systemic or viscerogenic pain or symptoms that can be referred to the chest or breast. This will include the cardiovascular, pulmonary, upper GI, neuromusculoskeletal systems, as well as other causes such as anxiety, steroid and cocaine use. 

The instructional focus of this course is on developing advanced clinical reasoning skills related to determining a client’s appropriateness for physical therapy. The course builds on concepts of evidence-based clinical practice as they are used to identify systemic or viscerogenic conditions affecting the chest and/or breast that might mimic neuromuscular or musculoskeletal dysfunction.

Upon completion of this course, the Learner will be able to: 
  • List possible causes of viscerogenic or systemic-induced chest and/or breast pain and dysfunction 
  • List signs and symptoms of systemic origin affecting the chest and breast  
  • Describe pain patterns referred to the chest and/or breast originating from the viscera or diseases including:  
    • Pulmonary 
    • Upper Gastrointestinal (GI)/epigastric
    • Vascular 
    • Neuromusculoskeletal
    • Other Causes
  • Recall special questions to ask men and women with significant risk factors. The focus will be on questions associated with any significant past medical history, suspicious clinical presentation and/or associated signs and symptoms that correlate with systemic disease presenting as chest and/or breast pain.
  • Describe conditions requiring medical referral

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