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.

Causes

Costal chondritis is an inflammatory process in cartilage, usually without any specific cause. Repeated minor chest injuries and acute respiratory infections can cause soreness in the area of ​​attachment of the ribs (both the effects of the viruses themselves and frequent coughing on the areas of attachment of the ribs). Sometimes costal chondritis occurs in people who take parenteral drugs or after surgery on the chest. After surgery, damaged cartilage tissue is more susceptible to infection due to impaired blood supply.

Symptoms

Chest pain associated with costal chondritis is usually preceded by physical exertion, minor trauma, or acute upper respiratory infections.

• The pain is usually acute and localized in the anterior region of the chest. The pain may radiate down or more often to the left side of the chest.
• The most common localization of pain is the region of the fourth, fifth and sixth ribs. Pain is aggravated by movement of the body or deep breathing. And, conversely, there is a decrease in pain at rest and with shallow breathing.
• Soreness, which is clearly detected on palpation (pressure in the area of ​​​​attachment of the ribs to the sternum). This is a characteristic feature of chondritis and the absence of this feature suggests that the diagnosis of costal chondritis is unlikely.

When costal chondritis is caused by a postoperative infection, swelling, redness and/or pus may be seen in the area of ​​the postoperative wound.

Considering that the symptoms of chondritis are often similar to emergencies, it is necessary to urgently seek medical help in the following cases:

• Breathing problems
• High temperature
• Signs of an infectious disease (swelling, redness in the area of ​​attachment of the ribs)
• Persistent chest pain with nausea, sweating
• Any chest pain without clear localization
• Increased pain during treatment

Diagnosis

Diagnosis is based on the medical history and external examination. Characteristic of this syndrome is pain on palpation in the attachment area of ​​4-6 ribs.

Radiography (CT, MRI) is usually not very informative for the diagnosis of this syndrome and is used only for differential diagnosis with other possible causes of chest pain (cancer, lung disease, etc.). ECG, laboratory tests are necessary to rule out heart disease or infections. The diagnosis of costal chondritis is made last, after all possible other causes (especially heart disease) have been ruled out.

Treatment

If the diagnosis is verified, then the treatment consists in the appointment of NSAIDs for a short time, physiotherapy, restriction of physical activity for a certain period of time, sometimes injections of an anesthetic together with a steroid into the area of ​​pain localization.

“Extra-cardiac” causes of chest pain

“Extra-cardiac” causes of chest pain – Polyclinic news

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January 22, 2021

If there is pain in the chest, then the first thing we suspect is that it hurts the heart. However, not only the heart muscle is located in the chest. Other organs can also signal problems with chest pains.

1. Intercostal neuralgia – irritation or inflammation of the intercostal nerves. Such pain is most often mistaken for a heartache. This is a sharp or shooting pain, aggravated by any movement and tension of the chest, for example, sneezing, coughing. Most often, this is how osteochondrosis manifests itself – degenerative-dystrophic changes in the spine.
2. Bone pain is similar to neurological and muscle pain. It is caused by trauma, tumors or inflammatory lesions in the bones.
3. Diseases of the bronchi, lungs are manifested by pain in the chest. Pain on the one hand, become stronger when inhaling, during movement. An additional symptom of pulmonary diseases is a cough.
4. Inflammation of the trachea causes sore pain in the middle of the chest. Characteristic cough.
5. Diseases of the esophagus and stomach can also be manifested by pain and burning behind the sternum and in the region of the heart.