Costochondritis Information | Mount Sinai

Chest wall pain; Costosternal syndrome; Costosternal chondrodynia; Chest pain – costochondritis

All but your lowest 2 ribs are connected to your breastbone by cartilage. This cartilage can become inflamed and cause pain. This condition is called costochondritis. It is a common cause of chest pain.

The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

Causes

There is often no known cause of costochondritis. But it may be caused by:

• Chest injury
• Hard exercise or heavy lifting
• Viral infections, such as respiratory infections
• Strain from coughing
• Infections after surgery or from IV drug use
• Some types of arthritis

Symptoms

The most common symptoms of costochondritis are pain and tenderness in the chest. You may feel:

• Sharp pain at the front of your chest wall, which may move to your back or stomach
• Increased pain when you take a deep breath or cough
• Tenderness when you press the area where the rib joins the breastbone
• Less pain when you stop moving and breathe quietly

Exams and Tests

Your health care provider will take your medical history and do a physical exam. The area where the ribs meet the breastbone is checked. If this area is tender and sore, costochondritis is the most likely cause of your chest pain.

A chest x-ray may be done if your symptoms are severe or do not improve with treatment.

Your provider may also order tests to rule out other conditions, such as a heart attack.

Treatment

Costochondritis most often goes away on its own in a few days or weeks. It can also take up to a few months. Treatment focuses on relieving the pain.

• Apply hot or cold compresses.
• Avoid activities that make the pain worse.

Pain medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may help to ease pain and swelling. You can buy these without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Take the dose as advised by the provider. Do not take more than the amount recommended on the bottle. Carefully read the warnings on the label before taking any medicine.

You may also take acetaminophen (Tylenol) instead, if your provider tells you it is safe to do so. People with liver disease should not take this medicine.

If your pain is severe, your provider may prescribe stronger pain medicine.

In some cases, your provider may recommend physical therapy.

Outlook (Prognosis)

Costochondritis pain often goes away in a few days or weeks.

When to Contact a Medical Professional

Call 911 or the local emergency number, or go to your local emergency room right away if you have chest pain. The pain of costochondritis can be similar to the pain of a heart attack.

If you have already been diagnosed with costochondritis, contact your provider if you have any of the following symptoms:

• Trouble breathing
• A high fever
• Any signs of infection such as pus, redness, or swelling around your ribs
• Pain that continues or gets worse after taking pain medicine
• Sharp pain with every breath

Prevention

Because the cause is often unknown, there is no known way to prevent costochondritis.

Crasto JA, Vaswani RS, Pauyo T, Musahl V. Overview of sport-specific injuries. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Hanak JA. Tietze syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 117.

Kurz J. Costosternal syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 101.

Last reviewed on: 10/20/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What Is Costochondritis?

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on January 04, 2023

• What Is Costochondritis?
• Costochondritis Causes
• Costochondritis Symptoms
• Costochondritis Diagnosis
• Costochondritis Treatment
• How Long Does Costochondritis Last?
• More

Costochondritis is when the cartilage (connective tissue) that joins your ribs to your breastbone is inflamed. Doctors call this area of your body the costochondral joint.

If you press on your upper ribs and it feels tender, or if your chest hurts when you move around, you may have it. The pain can start suddenly or gradually. 

One study found that 30% of people complaining of chest pain had costochondritis. The condition affects both children and adults, but is more common in people 40 and over. It’s more likely to affect women and people of Hispanic origin.

Is costochondritis dangerous? This condition is mostly harmless. But if you have sudden chest pain, always have it checked out by a doctor to make sure your heart is healthy. Unlike costochondritis, a heart attack often causes widespread pain along with symptoms like sweating, nausea, and a hard time breathing.

Injury, physical strain, respiratory infection, rheumatoid arthritis or psoriatic arthritis, chest wall infections, tumors, or rare conditions like relapsing polychondritis may also cause chest pain.

There isn’t a single known cause of costochondritis. Doctors aren’t sure how your costochondral joint gets inflamed. But they do know that inflammation is one way your body responds to injury or infection. The condition has been linked to:

• Strain due to exercise or exertion 
• Chest injury
• Lots of coughing 
• Infection, such as respiratory infections 
• Intravenous (IV) drug use

When your costochondral joint becomes inflamed, it results in chest pain and tenderness. Most people describe the pain as sharp, achy, and pressure-like. When you press on your chest, it feels tender and painful. The pain usually gets worse when you move around, breathe deeply, or sneeze. Some people have pain when they wear a seatbelt, hug someone, or lie down. 

Costochondritis pain locations. You usually first feel pain on the front left side of your breastbone. It often affects more than one rib. It may spread to the rest of your chest, and even affect your arms and shoulders. 

Your doctor will do a physical exam, pressing on your chest to check for areas of tenderness. They will also take a look at your range of motion and listen to your breathing. 

If you’re over 35, at risk for coronary artery disease or a blood clot, or you recently had a respiratory infection, your doctor may order more tests, like a chest X-ray and EKG, to rule out more serious problems.

Since costochondritis isn’t dangerous, treatment focuses on pain relief. Most of the time, chest pain from costochondritis will go away on its own. In the meantime, you can try one or more of the following on your own:

• Taking over-the-counter (OTC) pain relievers like aspirin or ibuprofen 2-3 times a day (making sure to follow the directions on the label carefully)
• Using hot compresses or heating pads in the painful area
• Avoiding activities, like strenuous exercise or reaching up, that make the pain worse

Talk to your doctor before taking OTC pain medications if you have:

• High blood pressure
• Heart disease
• Kidney disease
• Liver disease
• Past stomach ulcers or internal bleeding.

If your chest pain won’t go away or gets worse, see your doctor. They can give you a shot of a powerful anti-inflammatory medicine called a corticosteroid to reduce pain and swelling. They’ll inject the corticosteroid into the area where you’re feeling pain. But because having too much of a corticosteroid can damage your costochondral joint, you can only have this treatment once every few months.  

Your doctor might also try a procedure called transcutaneous electrical nerve stimulation, or TENS. A doctor or nurse puts adhesive patches on your skin near where you’re feeling pain. They use a TENS device to send a weak electrical current into your skin through the patches. It’s thought to work by stopping pain signals from reaching your brain.

Your doctor can also give you information on how to improve your posture and fix any muscle imbalances.

If necessary, they can refer you to a specialist called a rheumatologist, who treats diseases of the joints, muscles, and bones. 

Costochondritis isn’t a permanent condition. Most of the time, your chest pain will go away within a couple of weeks.

But in some cases, symptoms can linger for months. And sometimes it comes back again after it heals. About a third of those with costochondritis will have it for about a year. 

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Rib cancer – symptoms, methods of treatment, prevention and diagnosis

Ribs in the body of each person are arcuate bones connected to the spinal column and sternum to protect the located internal organs of a person from negative external influences.

Rib cancer is a rare and severe malignancy that most commonly affects children and males, and women are rarely affected. The danger of rib cancer is that, due to the location of these bones, the resulting metastases quickly spread to the heart and lungs.

The latent course is that a person does not have pain in the ribs in the early stages of cancer, which seriously reduces the chances of timely detection of the disease and successful future treatment. A malignant formation can occur in any rib, which becomes a difficult test for the patient, since even with successful treatment there is no guarantee that a relapse will not occur.

Causes of rib cancer

The main causes of rib cancer are:

• gene mutations that disrupt metabolic processes in bone tissue and contribute to the fact that cancer can form on the chest on the rib;
• radioactive radiation accumulated in bone tissue during the treatment of any other disease with the help of radiation therapy;
• the use of food products with a high content of carcinogens that have a negative effect on the DNA of cells;
• autoimmune processes occurring in the body and having a negative impact on metabolic processes in bone tissue;
• frequent and prolonged intoxication with harmful substances that accumulate in the bones;
• lung cancer with rib metastases.

The disease can occur under the influence of several causes at once, or in some cases gradually develop in the human body for absolutely no reason.

Signs, symptoms and manifestations of rib cancer

Rib cancer is a malignant tissue lesion in the body with atypical and infiltrating ongoing growth of cancer cells. The main manifestation of this disease is pain in the chest. At first, pain in the rib with cancer does not bother the person or is insignificant. After a while, it becomes more intense and uncomfortable.

Cancer of the rib bone can be Ewing’s sarcoma or osteosarcoma, in which long-term pain is not relieved by taking analgesics. Often, pain during the formation of cancer on the chest on the rib is felt when inhaling and intensifies at night.

A visible neoplasm is rarely visible, because the growth of the tumor deep into the sternum is mainly noted. In some cases, the doctor may feel for a loose seal. With progression, the tumor increases, the vascular network protrudes, the skin stretches, swells and turns red. Some types of sarcomas begin to hurt a lot when pressed, while others develop absolutely painlessly. For example, pain in the ribs may occur with lung cancer.

Symptoms and manifestations of rib cancer:

• fever;
• increase in anemia;
• feeling of general weakness;
• the appearance of neurological disorders in the form of paranoia or excessive agitation;
• shortness of breath due to lung involvement;
• ribs hurt with cancer.

Timely detection and correct effective treatment give people a favorable chance for recovery.

Stages of rib cancer

The stages of rib oncology are established on the basis of the histological examination and the data obtained from the instrumental examination:

• Stage I – low-grade tumors without metastases;
• stage II – highly malignant tumors without the formation of metastases in cancer;
• stage III – without metastases with the presence of foci of cancer in the rib bone;
• IV stage – tumors with metastases in different organs or in regional lymph nodes.

When should I see a doctor?

A sign of possible serious health problems is the feeling of pain in the rib with cancer. In case of weakness, increased fatigue and sudden weight loss for no apparent reason, it is recommended to contact a general practitioner who, after passing all the necessary tests and suspecting rib cancer, will send you to an oncologist, a radiologist and a chemotherapy specialist.

Qualified specialists of the oncological clinic “Sofia” in Moscow provide the necessary assistance and receive patients in departments located near the Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya and Chekhovskaya metro stations.

Diagnosis of rib cancer

MRI and radionuclide methods are the most informative method for detecting oncology at the Sofia Cancer Center in Moscow. These are PET/CT, scintigraphy and SPECT.

Early diagnosis with MRI helps to detect cancer at an early stage. The use of radionuclides is based on the property of their accumulation in areas of the body with ongoing metabolism. In the study, a substance with a weak isotope is injected into the vein, which, when irradiated, makes it possible to study cellular metabolism. The obtained results allow choosing the right treatment strategy and monitoring its effectiveness.

Radionuclide diagnostics are presented in the following types of examinations:

• PET/CT – the results of the spread of radionuclides are superimposed on CT images to increase the accuracy of disease detection;
• SPECT – with its help, three-dimensional projections of areas of possible localization of cancer are created;
• scintigraphy is used to create three-dimensional images and records the slightest malfunctions in the functioning of organs.

Competent diagnostics will allow to differentiate this disease from lung cancer with metastases to the ribs.

Drawing up a plan for the treatment of rib cancer

An examination plan for a disease is noted after an x-ray, which gives an idea of ​​the ongoing process in the human body. The tactics of treating the patient and the prepared plan are determined by the doctor in accordance with the data obtained from the examination.

Treatment of rib cancer

In the oncological center “Sofia” in Moscow for the treatment of rib cancer:

• chemotherapy;
• surgical treatment;
• radiotherapy;
• fractionated radiotherapy.

Rib cancer prognosis and prevention

There are different prognoses for rib cancer in this disease. Patients with aggressive cancer and metastases rarely live beyond 5 years. At stage 4 cancer, they can live for several months. The prognosis worsens with a large size of the neoplasm or the absence of the possibility of an operation. A pathological fracture of the rib in oncology can also occur.

Health status and age also play an important role. For example, children, unlike adults, tolerate treatment more easily and recover much faster.

Prevention of rib cancer consists in conducting periodic medical examinations of people who are at high risk. It also requires a serious approach to the treatment of precancerous pathologies, including benign bone neoplasms.

If you are visiting our website, you or your loved ones may have been diagnosed with cancer. We ask you to take a short survey and answer a few questions so that we can supplement the page with useful information.

How to make an appointment with a specialist?

Our specialists carry out prompt diagnostics of any oncological diseases. Doctors determine not only the type of cancer, but also its degree. Thanks to the use of modern equipment and the latest medical technologies, we can be sure of the accuracy of the results obtained. This is influenced by the high professionalism, as well as the experience of the doctors of the clinic.

To make an appointment, you can call +7(495)995-00-33, order a call back or fill out the request form.

Sofia Cancer Center is located in the center of Moscow at the address: 2nd Tverskoy-Yamskoy per., 10 (near Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya and Chekhovskaya metro stations).

INTERCOSTAL NEuralgia

The human nervous system is very well developed. When a “trouble” happens to her, she makes itself felt, causing certain symptoms. A fairly common pain syndrome is intercostal neuralgia . The word neuralgia itself combines two concepts. “Nevron” meaning “nerve” and “algos” meaning “pain”. Accordingly, the disease is the soreness of the nerves located between the ribs (intercostal nerves).

SYMPTOMS OF INTERCOSTAL NEuralGIA

There are certain symptoms that make it possible to “recognize” this disease. How can you recognize him anyway?

The most important symptom indicating the presence of intercostal neuralgia is pain localized between the ribs – in the intercostal spaces. The area of ​​the chest from the fifth to the ninth ribs is most often affected. By itself, the pain is quite diverse, it either appears in attacks, or it constantly worries a person, while preventing him from performing his usual movements of the upper half of the body. Many patients even get used to it, so they often remember its existence only during exacerbation.

What triggers an attack of pain?

It can occur with any movements that contribute to the stretching of these same intercostal spaces. Very often, pain can occur (or intensify) during a deep breath, or when a person tries to speak loudly. Coughing and sneezing are also accompanied by chest pain. If you press on the area between the ribs, it is painful. Sometimes it seems to patients that their chest is burning, or “prickly”, and some, touching the “sore” place, simply do not feel anything, because numbness along the intercostal nerves is also a sign of their defeat.

Patients can take an antalgic position, one in which pain sensations decrease or disappear. In this case, the patient can tilt the upper body in the direction opposite to the one where the pain is localized.

The intercostal nerves are strongly branched, their branches are directed in different directions, so the pain of intercostal neuralgia can be similar to the pain of other diseases.

Given the possible abrupt nature of the occurrence of an attack of pain, it can mimic an attack, for example, with angina pectoris. The patient can independently determine whether the heart or nerve endings hurt.

If this is angina pectoris, then the pain is necessarily localized behind the sternum, it presses, pulsates, in addition, there are violations of the pulse, pressure, and when the posture changes, the pain does not change its character.

If it is intercostal neuralgia , then the pressure and pulse are normal, but the nature of the pain changes with the slightest stretching of the intercostal spaces. Branches of the intercostal nerves even reach the lower back, so it is often possible to confuse an attack of neuralgia with an attack of colic in the kidneys. If a patient has pain in the area of ​​the shoulder blades, along the spine or in the shoulder, as if they are being injected or cut with a knife, this may also indicate intercostal neuralgia. In addition, if at the same time pain sensations increase when the muscles of these areas are stretched, then this once again confirms the diagnosis.

CAUSES OF INTERCOSTAL NETURALGIA

Painful sensations may occur due to a certain reflex from the intercostal nerves, provoked by the action of exogenous (formed outside the body) and endogenous (formed in the human body) factors. Under the influence of provoking factors, the nerves are irritated, which causes pain. Depending on how strong the irritating factor is, the pain is so intense.

Progressive thoracic osteochondrosis is the most common cause of the development of the disease, as it is observed:

• spinal instability – displacement of the vertebrae, which cause infringement of the roots of the spinal nerves and disrupt their proper functioning,
• disc protrusions or herniations are formed between the vertebrae, and they can exert compression (pressure), i.e. irritate the intercostal nerves, namely their roots, damaging them, which causes pain at the site of infringement (irritation) and along the nerve.

Herpes zoster (popularly known as shingles) is also a fairly common cause.

Intercostal neuralgia may be the result of a certain disease of the spine, and under the influence of certain irritating factors, it is outwardly manifested by pain along the intercostal nerves. Such diseases include spondylitis, spondyloarthritis, ankylosing spondylitis, and various neoplasms (benign or malignant tumors) localized in the spine can also irritate the nerves.

In principle, any kind of factor can cause an attack of pain: physical, chemical, biological. As mentioned earlier, when performing sharp or unusual physical exercises without any preparation, the muscles in the intercostal spaces are suddenly stretched, which leads to irritation of the nerve endings. In addition, normal hypothermia, either the flu or the herpes virus (which causes shingles) can also irritate the nerve endings. Irritating factors also include intoxications of any origin (viral, alcoholic, intoxication with paints and varnishes, etc. ), excessive emotional excitability or trauma to the chest. But the symptoms indicating neuralgia of the intercostal nerves can be not only the result of the direct action of the stimulus on these nerve endings, they can also reflect pathological processes in nearby organs and tissues.

So, intercostal neuralgia can “copy” the clinic of an inflammatory disease of the pleura (pleurisy), narrowing of the part of the aorta located in the thoracic region, mediastinal neoplasms (benign or malignant), any inflammatory or deforming processes of the spine, and so on.

Therefore, given that a huge number of diseases of both the musculoskeletal system and other systems, individual organs and tissues of a person can cause symptoms similar to intercostal neuralgia, you should not independently determine what kind of disease it is, and even more so try to treat it , since, by curing, as you think, the true cause of the disease, you may miss or aggravate another – the main cause, which can lead to unpleasant and dangerous consequences that you will have to deal with for a long time. Therefore, upon discovering the first signs of damage to the nerve endings, immediately consult a doctor.

PREVENTION OF INTERCOSTAL NEURALGIA

The general methods of prevention are quite simple and are aimed at preventing irritation of the intercostal nerves. You need to do morning exercises regularly, it is advisable to visit the pool, try to limit yourself in physical exertion, especially heavy ones, dress warmly, avoid drafts so as not to overcool and catch a cold. And, of course, in the presence of the underlying disease (from viral infection to the final stage of osteochondrosis), treat it.

DIAGNOSTICS OF INTERCOSTAL NERALGIA

First of all, you can make a diagnosis yourself, which will only allow you to suspect the disease, after which you should immediately consult a doctor.

How is it done?

First, it is worth trying to determine exactly what this pain is, where it is located and why, in fact, it arose. Soreness can persist for a long time, or it can disappear, manifesting itself in attacks. You can palpate (feel) the ribs, and most importantly, the spaces between them. If this is a lesion of the intercostal nerves, then it is the intercostal spaces, and not the ribs themselves, that will hurt. You can try to tilt the upper body in different directions, twist, try to cough or even scream. All this leads to stretching of the muscles located between the ribs, irritation of the endings. If the symptoms are similar to the desired disease, you should try to remember or connect this pathology with any previous disease. For example, does the patient have a disease of the musculoskeletal system, did he have a recent cold, did he get cold, did he suddenly go to the gym after a long break, or were there any factors contributing to the development of intoxication (drinking alcohol, inhaling varnishes or paints, etc.).

The next examination is done by a doctor. First of all, he conducts a detailed questioning of the patient. The doctor asks about the nature of the pain sensation (pain is cutting, burning, dull, pressing, aching, and so on), about its location (at a certain point or throughout the chest), does the pain radiate to the shoulder blade, lower back, possibly to other parts body.