The Myofascial Continuum: Anatomical Insights Into Noncardiac Chest Pain

Angina, commonly known as chest pain, is the primary symptom of ischemic heart disease and can also present as pain in the neck, shoulder, jaw, arm, or back. Noncardiac chest pain (NCCP) is a common disorder with various causes, marked by recurrent chest pain that mimics ischemic heart pain. While gastroesophageal reflux disease is recognized as the most common cause, the symptoms can also arise from musculoskeletal disorders of the chest wall and upper limbs. Although spinal dysfunction, Tietze syndrome, costochondritis, and slipping ribs have been associated with chest pain, the myofascial etiology of NCCP remains unclear and underdiagnosed. This review explores the structural myofascial continuum (MC) connecting the segments of the upper quadrant, including the neck, chest, and upper limbs. It also highlights the plausible role of the myofascial continuum in NCCP and its associated plethora of symptoms. Although studies have demonstrated myofascial expansions in which the deep fascia connects the various muscles of the upper quadrant, their role remains unclear. Painful symptoms concomitant with musculoskeletal chest pain arise from impairment of the myofascial continuum. Comprehending the intricate myofascial connections between the neck, chest, and upper limbs is crucial for clinicians seeking to improve the evaluation and treatment of NCCP.