Precordial Catch Syndrome
1. Search strategy
2. Definition
3. Clinically relevant anatomy
4. Epidemiology/etiology
5. Characteristics/ clinical presentation
6. Differential diagnosis
7. Diagnostic procedures
8. Outcome measures
9. Examination
10. Medical management
11. Physical therapy management
12. Key research
13. References
1. Search strategy
2. Definition/Description
Precordial catch syndrome (Texidor’s Twinge) is a common, but underrecognized cause of benign chest pain in children and adolescents.
The pathophysiology of the syndrome is unknown. 1
3. Clinically Relevant Anatomy
Anatomy of the sternum
4. Epidemiology/etiology
Precordial catch syndrome may occur at any age, but usually occurs in children aged 6 to 12 years. There is no sex predilection. The pain usually occurs while the patient is at rest, but never occurs during sleep. It has no temporal correlation with meals. 1
5. Clinical presentation
The pain is usually sudden and sharp and localizes to one intercostals space along the left lower sternal border or to the cardiac apex. The origin of the pain is unknown. The pain occurs either at rest or during mild activity and is exacerbated with inspiration which often leads to shallow breathing in an effort to alleviate pain. The episodes usually lasts between 30 seconds and 3 minutes but occasionally they resolve after a breath or two and rarely may last up to 30 minutes. There are no associated symptoms and physical examination is negative. 1,2,3
6. Differential diagnosis
Angina pectoris can occur in persons with congenital, inflammatory or atherosclerotic causes of coronary insufficiency, aortic valve stenosis and hypertrophic cardiomyopathy. This pain is rarely described as sharp, is not well localized, tends to begin and resolve insidiously and is provoked by exercise or activity. 1
Mitral valve prolapse occasionally causes atypical chest pain, which may be sharp and well localized. However, this pain is not exacerbated with deep breaths and is accompanied by the click and murmur characteristic of this condition. 1
The chest pain caused by pericarditis is associated with acute illness and is not transient, intermittent or well localized. 1
Viral pleuritis or pleurodynia may produce sharp chest pain similar in character to precordial catch syndrome, but it is usually associated with fever and cough and is generally unrelenting. 1
Chest wall syndrome and chest trauma, including rib fractures, can produce pain very similar to precordial catch syndrome. A history of trauma and localized tenderness of the chest wall are present. 1
7. Diagnostic procedures
The diagnostic evaluation for precordial catch syndrome should consist almost exclusively of a careful history-taking and physical examination. 1 Plain radiographs are indicated for all patients who got pain thought to be emanating from the chest wall, to rule out occult bony disorders. If trauma is present, radionuclide bone scanning should be considered to exclude occult fractures of the ribs or sternum. Given the location of the pain, an electrocardiogram and an echocardiogram are indicated, but in patients with precordial catch syndrome, the results are expected to be normal. Based on the patient's clinical presentation additional testing may be indicated (blood count, prostate-specific antigen level, erythrocyte sedimentation rate and antinuclear antibody testing). Magnetic resonance imaging of the joints is indicated if there is joint instability. 4
8. Outcomes measures
9. Examination
10. Medical management
Pharmacologic treatment is not indicated, given the rapid onset and offset of the pain. 4
11. Physical therapy management
Treatment of precordial catch syndrome consists of a combination of reassurance and instructing the patient to take a deep breath as soon as the pain begins. 4
Reassurance:
Explain that chest pain is a common complaint among children and, unlike in adults, it is seldom cardiac in origin. More specific discussion of the patient's symptoms and the features (sharpness, localization, relation to deep breathing, predominance at rest) that clearly distinguish this condition from cardiac pain is important.
Naming the symptoms (precordial catch syndrome or Texidor's twinge) emphasizes certainty and familiarity with the diagnosis.
Reassurance must be offered that the pain is completely harmless 1.
12. Key research
13. References:
1. Gumbiner C, Precordial Catch Syndrome; Southern Medical Association, 2003
Level of evidence: 5
2. Surendranath R, Veeram R, Harinder R; Chest Pain in Children and Adolescents;
Pediatrics in Review, 2010, Vol 31
Level of evidence: 4
3. Thull-Freedman J; Evaluation of Chest Pain in the Pediatric Patient; Med Clin N Am 94
(2010) 327-347
Level of evidence: 5
4. Waldman S; Atlas of Common Pain Syndromes; Elsevier Inc, 2012
Level of evidence: 5
