Unexplained rib & chest wall painMonths — sometimes years — of rib or chest pain. The heart checked and cleared. Scans reported as normal. Then nothing but painkillers and reassurance. Chest wall pain almost always has a findable cause: it needs a structured assessment by someone who examines the chest wall for a living.
Page last updated 5 August 2026
When the heart, lungs and gut have been cleared, these are the diagnoses that account for most persistent rib and chest wall pain — and most of them are made by examination.
Inflammation where ribs meet the breastbone: tender at specific points, worse with deep breaths and movement. Usually settles — but persistent “costochondritis” deserves a second look, because it is a common mislabel for other conditions on this list.
Burning, shooting or band-like pain along the line of a rib, from an irritated intercostal nerve — after injury, surgery, shingles, or entrapment. Responds well to targeted nerve blocks and, where needed, cryoablation.
Sharp lower-rib pain with clicking, triggered by movement, invisible on scans. Diagnosed in minutes with the hooking manoeuvre.
Dedicated slipping rib page →Pain and tenderness at the small cartilage tip at the bottom of the breastbone, aggravated by bending, large meals or pressure. Treated with local measures, injection — and xiphoidectomy in persistent confirmed cases.
Seen in rowers, golfers, throwers — and after prolonged violent coughing. Often invisible on first X-rays; picked up on targeted imaging and settled with structured load management.
Pain persisting long after a rib fracture “healed” — usually malunion, nonunion or nerve damage. All treatable.
More below ↓When it started, what triggers it, what every previous test showed. Mr Scarci reviews all existing imaging and letters before you arrive.
Point-by-point palpation of the costal cartilages, sternum, xiphoid and rib margins — including the hooking manoeuvre most patients have never had.
Dynamic ultrasound, specific CT or MRI views, or bone imaging — requested to answer a question, not to fish.
Local anaesthetic at the suspected source that abolishes the pain confirms the diagnosis and brings relief in the same appointment.
Anti-inflammatories, neuropathic agents and lidocaine patches — chosen for the actual diagnosis rather than dispensed for “chest pain”.
Breathing mechanics, thoracic mobility and postural drivers addressed by physiotherapists used to chest wall problems.
Image-guided injections for relief lasting weeks to months; cryoablation for nerves sensitised by years of irritation.
Xiphoidectomy for confirmed xiphoid syndrome, refixation of painful nonunions, costal cartilage resection for slipping ribs — reserved for confirmed diagnoses that have failed conservative care.
Because “healed on X-ray” and “back to normal” are not the same thing. Three specific problems explain most chronic post-fracture pain:
The rib knitted in a poor position, changing chest wall mechanics with every breath.
The fracture never fully joined, leaving a subtly mobile, painful segment.
The nerve under the rib was injured or trapped in scar as things healed.
Each has a different treatment — from nerve blocks and cryoablation to surgical refixation with titanium plates — which is exactly why “learn to live with it” is rarely the right final answer.
More on rib fracture treatmentSudden severe breathlessness at rest, coughing up blood, blue lips or fingertips, crushing central chest pain, fainting, or a section of the chest visibly moving the wrong way with breathing: these need an emergency ambulance, not an outpatient appointment.
New, unassessed chest pain? Have cardiac causes excluded first — via 999 for acute severe symptoms, or urgently through your GP or A&E. This clinic is the right next step once the heart has been cleared and the pain remains.
“ ★★★★★“Two A&E visits, a normal angiogram, and six months of pain. I was starting to believe it was in my head. Mr Scarci found the exact spot in about a minute — costochondritis at two junctions — and explained why every heart test had been normal. One injection later, the pain was gone.”
“ ★★★★★“After shingles the rash healed but the burning never left. Eighteen months of gabapentin from my GP with no real plan. A nerve block confirmed exactly which nerve it was, and cryoablation gave me my first pain-free months in two years.”
“ ★★★★★“Every time I bent over or ate a big meal I got a deep ache at the bottom of my breastbone. Gastroscopy normal, ultrasound normal, told it was probably reflux. It was xiphoid syndrome — an injection settled it, and I finally knew what I was dealing with.”
MD(Hons) · FRCS(Eng) · FCCP · FACS · FEBTS · Consultant Thoracic Surgeon, Imperial College Healthcare NHS Trust
Unexplained chest wall pain sits in a no-man’s-land of modern medicine: cardiology excludes the heart, gastroenterology excludes the stomach, and nobody owns what remains. Mr Scarci has spent over two decades owning exactly that territory — the muscles, cartilage junctions, nerves and bones of the chest wall, and the systematic examination that identifies which of them is the source.
He performs every examination personally, carries out any injections and procedures himself, and follows your recovery through — the same surgeon from first consultation to discharge.
Choose the day and hospital that suits you. The structured chest wall examination happens at your first visit.
St John’s Wood, NW8 9LE
11:00am–1:00pm Monday PMMarylebone, W1G 6BW
5:30–7:30pm Tuesday PMBorehamwood, WD6 3BS
5:30–7:30pm Wednesday AMHammersmith, W12 0HS
9:00–11:00am Thursday AMSouth Kensington, SW5 0TU
9:30am–12:30pmNot in London? Remote video consultations are available to review your history and existing results before you travel.
You don't — until it has been checked, which is why new chest pain should always have cardiac assessment first, and why crushing central pain, breathlessness or pain radiating to the jaw or arm means 999, not an outpatient clinic. Most patients arriving here have already had normal cardiac tests. That is the right order: heart first, then a proper answer for the pain that remains — because “it isn't your heart” is a relief, not a diagnosis.
Inflammation of the cartilage joining the ribs to the breastbone — tender to the touch at specific points, worse with deep breaths and certain movements. Most cases settle within weeks to a few months with anti-inflammatories and activity adjustment. When it persists or keeps recurring, the job is to confirm the diagnosis is actually right — long-lasting “costochondritis” is sometimes a slipping rib, a nerve problem or a xiphoid syndrome in disguise.
Pain and tenderness centred on the xiphisternum — the small cartilage tip at the bottom of the breastbone. It can follow trauma, vigorous exercise, or arise on its own, and is aggravated by bending, large meals or tight clothing. Treatment ranges from reassurance and anti-inflammatories to local injection, and in persistent, confirmed cases, surgical removal of the xiphoid (xiphoidectomy).
Because several of the most common chest wall diagnoses are clinical, not radiological: costochondritis, intercostal neuralgia, slipping rib syndrome and xiphoid syndrome are all made — or missed — on examination. Scans exclude other causes; they rarely provide the answer by themselves. The pathway here starts with a detailed history and a structured physical examination, and uses imaging and diagnostic nerve blocks to confirm, not to fish.
Yes. Malunion (healing in a poor position), nonunion (never fully healing), and intercostal nerve damage can all leave pain long after the bone was declared healed — and all three are identifiable and treatable, from nerve blocks and cryoablation to surgical refixation. Old pain is not automatically permanent pain.
Yes — assessment and treatment of chest wall pain, including diagnostic nerve blocks and any surgery, is recognised by the major UK insurers, and the practice manages authorisation for you. Self-pay patients receive written estimates in advance, and remote consultations are available to review your history and imaging before you travel.
A structured chest wall assessment finds the cause behind most “unexplained” rib and chest pain — and pairs it with treatment that actually matches. You leave with an answer and a plan.
