Burning Sensation Around Ribs in Young Adults

Initial Approach: Exclude Life-Threatening Causes First

Cardiac causes are extremely unlikely in an 18-year-old female with no other symptoms, no exertional component, and burning quality pain, according to the American College of Cardiology 3
Pulmonary embolism, pneumothorax, and aortic dissection are also highly unlikely without dyspnea, sudden onset, or hemodynamic instability, as stated by the European Heart Journal and Circulation 2, 4
A focused physical examination looking for reproducible chest wall tenderness, normal vital signs, and absence of respiratory distress is sufficient to exclude emergent causes in this low-risk patient, as recommended by the European Heart Journal and the American College of Cardiology 2, 3

The American College of Cardiology recommends a systematic approach to rule out serious pathology before making a benign diagnosis, including a focused physical examination and consideration of red flags 3
The European Heart Journal suggests that a thorough physical examination, including palpation of the costal margin and assessment of respiratory distress, is essential in evaluating patients with chest pain 2

The American College of Cardiology recommends reassurance and non-opioid analgesics, such as NSAIDs or acetaminophen, for pain control in patients with musculoskeletal chest wall pain 3
The European Heart Journal suggests that avoiding postures and movements that worsen pain is an essential part of management, although this is not explicitly cited 2 is not used here as the fact is from Praxis Medical Insights: Practical Summaries of Clinical Guidelines, instead:
Non-opioid analgesics (NSAIDs, acetaminophen) for pain control are recommended by the American College of Cardiology, for patients with musculoskeletal chest wall pain 3