Background: Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes.

Objective: This article describes the causes, assessment and differential diagnosis of musculoskeletal chest wall pain, and the management of its most common causes.

Discussion: It is critical to rule out non-musculoskeletal causes of chest pain, particularly those requiring urgent intervention such as ischaemic heart disease. However, once this has been done, most musculoskeletal diagnoses can be made from a thorough history and examination. Further investigations are often unnecessary and should only be used when the provisional diagnosis suggests they are needed, for example, when systemic or rheumatological causes are suspected. The evidence underpinning the treatment of specific localised causes of musculoskeletal chest wall pain is very limited.