Chest pain middle of rib cage. Costochondritis: Causes, Symptoms, and Treatment of Chest Wall Pain

17.04.202126.07.2023 by alexxlab

What are the common symptoms of costochondritis. How is costochondritis diagnosed. What treatments are available for costochondritis. Can costochondritis be prevented. When should you seek medical attention for chest pain.

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Understanding Costochondritis: A Common Cause of Chest Pain

Costochondritis is a condition characterized by inflammation of the cartilage connecting the ribs to the breastbone (sternum). This inflammation can cause sharp, localized chest pain that may be mistaken for more serious conditions such as heart attacks. While often benign and self-limiting, costochondritis can be quite uncomfortable and disruptive to daily activities.

What exactly is costochondritis?

Costochondritis occurs when the costal cartilage, which connects the ribs to the sternum, becomes inflamed. This inflammation can cause pain and tenderness in the chest wall, particularly where the ribs meet the breastbone. The condition is relatively common and can affect people of all ages, though it is more frequently seen in adults.

Recognizing the Symptoms of Costochondritis

The primary symptom of costochondritis is chest pain, which can vary in intensity and character. Understanding these symptoms can help differentiate costochondritis from other potentially more serious conditions.

What are the typical symptoms of costochondritis?

Sharp, aching, or pressure-like pain in the front of the chest
Pain that may spread to the back, abdomen, or arms
Increased pain when taking deep breaths, coughing, or sneezing
Tenderness when pressing on the affected area
Pain that worsens with physical activity or lying down
Discomfort that may last for several weeks or months

It’s important to note that while costochondritis can cause significant discomfort, it does not directly affect heart function or breathing. However, the pain may lead to shallow breathing as a way to avoid exacerbating the discomfort.

Potential Causes and Risk Factors for Costochondritis

The exact cause of costochondritis is not always clear, but several factors have been associated with its development. Understanding these potential triggers can help in prevention and management of the condition.

What factors contribute to the development of costochondritis?

Physical trauma or injury to the chest
Repetitive strain from activities involving the upper body
Severe or prolonged coughing
Viral or bacterial infections, particularly respiratory infections
Certain types of arthritis, such as rheumatoid arthritis or ankylosing spondylitis
Fibromyalgia
Certain exercises or physical activities that strain the chest wall

In some cases, costochondritis may develop without any apparent cause, making it challenging to pinpoint a specific trigger. This idiopathic nature of the condition can sometimes lead to frustration for both patients and healthcare providers.

Diagnosing Costochondritis: Ruling Out Serious Conditions

Given that chest pain can be a symptom of various conditions, some of which may be life-threatening, it’s crucial to obtain a proper diagnosis when experiencing persistent chest discomfort.

How do healthcare providers diagnose costochondritis?

Medical history: The healthcare provider will ask about the nature of the pain, its duration, and any factors that worsen or alleviate the symptoms.
Physical examination: The doctor will palpate the chest wall to identify areas of tenderness, which is a hallmark of costochondritis.
Ruling out other conditions: To exclude more serious causes of chest pain, the provider may order tests such as:
- Electrocardiogram (ECG) to check heart function
- Chest X-ray to examine the lungs and rib cage
- Blood tests to check for signs of inflammation or infection

Costochondritis is often a diagnosis of exclusion, meaning it is confirmed after other potential causes of chest pain have been ruled out. This approach ensures that more serious conditions are not overlooked.

Treatment Options for Managing Costochondritis

While costochondritis often resolves on its own over time, there are several treatment options available to manage pain and discomfort during the healing process.

How is costochondritis typically treated?

Rest and activity modification: Avoiding activities that exacerbate the pain
Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce inflammation and pain
Heat or ice therapy: Applying heat or cold packs to the affected area to alleviate discomfort
Gentle stretching exercises: To improve flexibility and reduce stiffness in the chest wall
Physical therapy: In some cases, to improve posture and strengthen chest muscles
Topical anti-inflammatory creams: Applied directly to the painful area
Transcutaneous electrical nerve stimulation (TENS): Using low-voltage electrical current to relieve pain

In more severe or persistent cases, additional treatments may be considered:

Corticosteroid injections: To reduce inflammation in specific areas
Intercostal nerve block: Injecting a local anesthetic to numb the affected nerves
Prescription pain medications: For short-term use in cases of severe pain

It’s important to work closely with a healthcare provider to determine the most appropriate treatment plan based on the severity of symptoms and individual health factors.

Lifestyle Modifications and Self-Care for Costochondritis

In addition to medical treatments, several lifestyle modifications and self-care strategies can help manage costochondritis and promote healing.

What self-care measures can help alleviate costochondritis symptoms?

Practicing good posture to reduce strain on the chest wall
Using a supportive bra for women to minimize breast movement and associated pain
Avoiding heavy lifting or strenuous upper body exercises during recovery
Implementing stress-reduction techniques such as deep breathing exercises or meditation
Applying a warm compress to the affected area for 15-20 minutes several times a day
Sleeping in a position that minimizes pressure on the chest, such as on the back with a pillow under the knees
Gradually returning to normal activities as pain subsides, under the guidance of a healthcare provider

These self-care measures can complement medical treatments and help speed up the recovery process. However, it’s important to consult with a healthcare professional before making significant changes to your lifestyle or exercise routine.

When to Seek Medical Attention for Chest Pain

While costochondritis is generally not life-threatening, it’s crucial to be able to distinguish between this condition and more serious causes of chest pain. Knowing when to seek immediate medical attention can be lifesaving.

In which situations should you seek emergency medical care for chest pain?

Sudden, severe chest pain that radiates to the arm, jaw, or back
Chest pain accompanied by shortness of breath, sweating, or nausea
Pain that feels like squeezing or pressure in the chest
Chest discomfort along with lightheadedness or fainting
Any chest pain lasting more than 15 minutes
Chest pain occurring with a rapid or irregular heartbeat

These symptoms could indicate a heart attack or other serious cardiac conditions that require immediate medical intervention. It’s always better to err on the side of caution when it comes to chest pain, especially if you have risk factors for heart disease.

Long-Term Outlook and Prevention of Costochondritis

Understanding the prognosis of costochondritis and ways to prevent its recurrence can help individuals manage their condition more effectively.

What is the typical prognosis for costochondritis?

For most people, costochondritis is a self-limiting condition that resolves within a few weeks to months. However, in some cases, it may persist for longer periods or recur intermittently. The long-term outlook is generally good, with most individuals making a full recovery and experiencing no lasting effects.

Can costochondritis be prevented?

While it’s not always possible to prevent costochondritis, certain measures may help reduce the risk of developing or exacerbating the condition:

Practicing proper form during exercise, especially when lifting weights
Avoiding overexertion and gradually increasing the intensity of workouts
Maintaining good posture throughout the day
Using protective gear during contact sports or activities that may result in chest trauma
Managing underlying conditions such as arthritis or fibromyalgia
Treating respiratory infections promptly to minimize severe coughing

By implementing these preventive strategies and being mindful of activities that strain the chest wall, individuals may be able to reduce their risk of developing costochondritis or experiencing recurrent episodes.

In conclusion, costochondritis, while often benign, can be a source of significant discomfort and concern for those experiencing it. By understanding its symptoms, causes, and treatment options, individuals can better manage the condition and distinguish it from more serious health issues. Always consult with a healthcare provider for persistent or concerning chest pain to ensure proper diagnosis and treatment. With appropriate care and management, most people with costochondritis can expect a full recovery and return to their normal activities.

Costochondritis – NHS

Costochondritis is inflammation where your ribs join the bone in the middle of your chest (breastbone). It can cause sharp chest pain, especially when moving or breathing. It usually gets better on its own over time.

Check if you have costochondritis

Costochondritis may cause sharp pain in the front or side of your chest.

The pain may be worse when:

moving your upper body
lying down
breathing deeply
you press the middle of your chest

Urgent advice: Get help from NHS 111 if:

you think you have costochondritis

It is important to get chest pain checked to rule out other more serious conditions.

You can call 111 or get help from 111 online.

Immediate action required: Call 999 if:

You have sudden chest pain that:

spreads to your arms, back, neck, or jaw
makes your chest feel tight or heavy
started with a shortness of breath, sweating, feeling sick or being sick
lasts more than 15 minutes

You could be having a heart attack. Call 999 immediately as you need immediate treatment in hospital.

Treatments for costochondritis

Costochondritis usually gets better on its own, over time. It can last for a few weeks to several months.

Painkillers that help with inflammation, like ibuprofen, may be recommended to help with the pain.

If you have very bad pain that does not get better over time, you may be offered a steroid injection to help reduce inflammation or local anaesthetic to ease the pain.

Causes of costochondritis

It is not always known what causes costochondritis, but it may be caused by:

an injury to your chest
repetitive upper body movements, like lifting
coughing a lot

Sometimes it may be caused by a problem with the joints in the back, or another underlying condition like fibromyalgia or rheumatoid arthritis.

It can also be caused by an infection.

Page last reviewed: 26 July 2022
Next review due: 26 July 2025

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.

Costal chondritis (Tietze’s syndrome) – treatment, symptoms, causes, diagnosis The disease is characterized by local pain in the chest, aggravated by palpation and pressure on these areas. Costal chondritis is a relatively harmless condition and usually goes away without treatment. The cause of occurrence is not known.

Costochondritis is a common cause of chest pain in childhood and adolescence and accounts for 10-30% of all chest pain in this age group. It most often occurs between the ages of 12-14 years.
Costal chondritis is also considered a possible diagnosis in adults who have chest pain. Chest pain in adults is considered a potentially serious symptom of the disease and, first of all, it is necessary to exclude the pathology of the heart (ECG, tests, examination, etc.). Only after a thorough examination and exclusion of the cardiac genesis of pain can we assume the presence of costal chondritis. Sometimes differential diagnosis is difficult. In adults, costal chondritis is more common in women.

Costal chondritis is often referred to as Tietze’s syndrome. Tietze’s syndrome is a rare inflammatory disorder characterized by chest pain and cartilage swelling at the attachment of the second or third rib to the sternum. The pain occurs acutely and radiates to the arm, shoulder. Both men and women get sick more often between the ages of 20 and 40. It occurs mainly in people whose work is associated with physical activity or athletes.