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

Symptoms, Causes, Tests, and Treatment

Costochondritis is an inflammation of the cartilage in the rib cage. It can happen due to infection, injury, and other health conditions.

This condition usually affects the cartilage where the upper ribs attach to the breastbone, also known as the sternum, in an area known as the costosternal joint or costosternal junction.

Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel slightly tender or some pain when you push on the area.

More severe cases may get worse with certain movements as well as with deep breaths. The condition often goes away within a few weeks or months, but some cases may require treatment.

People with costochondritis often experience chest pain in the upper and middle rib area on either side of the breastbone. This pain can gradually increase over time, or come on suddenly.

Additional symptoms can include:

• pain that becomes worse when lying down
• pain that becomes worse when there’s pressure on your chest, like when you wear a seatbelt
• pain that intensifies with coughing or deep breaths
• pain that increases with physical activity

It’s important to note that symptoms like chest tightness and radiating pain can indicate other conditions, including a heart attack. Seek immediate medical care if you’re experiencing persistent, intense chest pain.

The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:

• trauma to the chest, such as blunt impact from a car accident or fall
• physical strain from activities, such as heavy lifting and strenuous exercise
• certain viruses or respiratory conditions, such as tuberculosis, that can cause joint inflammation
• severe coughing

There’s some research that suggests costochondritis occurs more often in women, especially those who are athletes. You may also be at a higher risk for this condition if you:

• participate in high-impact activities
• recently had a physical trauma or fall that affected the chest area
• have allergies and are frequently exposed to irritants

While there’s no test to diagnose costochondritis, your doctor will most likely ask a series of questions and do a series of tests to determine the source of your chest pain.

Lab tests

Typically, lab tests aren’t needed to diagnose costochondritis, but depending on your personal health history, your doctor may do some tests to see if your chest pain could be due to other issues like pneumonia or coronary heart disease.

X-rays and ECGs

Your doctor may want you to get an X-ray to make sure there’s nothing abnormal going out with your lungs.

If you’re dealing with costochondritis, your X-ray should look normal. They may also recommend an electrocardiogram (ECG) to make sure your heart isn’t the cause of your chest pain.

Many times, diagnosing costochondritis is a matter of eliminating other possible, more serious causes.

See your doctor right away if you have trouble breathing or are feeling intense chest pain.

Always seek immediate emergency care when you have abnormal and debilitating pain in your chest. It can indicate something serious, such as a heart attack.

Getting care as soon as possible limits the possibility of complications, especially if an underlying issue is causing your costochondritis.

Costochondritis can be treated in several ways.

Most cases of costochondritis are treated with over-the-counter medications. If your pain is mild to moderate, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).

Your doctor may also recommend:

• prescription-strength NSAIDs
• oral steroids or injection of a steroid into the area involved
• transcutaneous electrical nerve stimulation (TENS), which is a mild electric current that is delivered to the area via a small, battery-powered device

Lifestyle changes

Your doctor may tell you to make permanent lifestyle changes if you have persistent or chronic costochondritis.

Some types of exercise can aggravate this condition, including rowing and weightlifting. Manual labor may also have a negative effect.

Your doctor may also recommend:

• rest
• physical therapy
• hot or cold therapy using a heating pad and ice

Normally, treatment of the inflammation and pain causes costochondritis to eventually go away on its own.

If you have chronic costochondritis, the pain may persist or return — even with treatment — when you exercise or engage in certain activities. In these cases, you may need to seek long-term care to make sure that costochondritis doesn’t affect your quality of life and ability to take part in daily activities.

Pains associated with costochondritis can indicate other issues. Chest pain can often mean that you’re having heart or lung issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or have pneumonia.

The chest pain associated with costochondritis can be a symptom of fibromyalgia. With fibromyalgia, you may experience soreness in your chest in addition to:

• pain throughout your body
• fatigue and inability to rest due to pain
• difficulty focusing or concentrating
• feelings of depression
• headaches

If you experience chest pains along with these other symptoms, talk with your doctor about getting tested for fibromyalgia. Understanding this condition can help you address the symptoms and ensure that it doesn’t interrupt your daily life.

Costochondritis is caused by inflammation and typically presents as chest pain that gets worse with certain movements or pressure. This condition usually isn’t persistent. In many cases, costochondritis goes away on its own.

Mild cases of costochondritis may disappear after a few days. Chronic cases can last for weeks or more, but most cases don’t last any longer than a year.

To lower your chances of developing persistent costochondritis, carry and lift heavy loads properly. Try doing fewer high-impact exercises or manual labor, when possible.

Seek medical attention immediately if you experience chest pain while performing any of these activities.

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.

Middle chest pain: possible causes, treatment

Doctors call the phenomenon when a person has pain in the chest in the middle, thoracalgia. There can be a lot of reasons for the appearance of pain syndrome, from the most harmless to quite serious pathologies. In order not to miss an important “alarm bell” from your body, it is best to turn to to a neurologist who will examine you and determine why your chest began to hurt.

Middle chest pain: causes

There can be many reasons why pain appeared in the middle of the chest, so it is worth considering the intensity of the pain syndrome, its frequency and the specific localization of pain. By doing this, it will be possible to narrow the search for pathology leading to unpleasant sensations.

Cardiac pathologies

Pain in the chest is often associated with diseases of the cardiovascular system, the heart. If you feel thoracic all the time, this may indicate an aortic aneurysm. In this case, the pain in the left or right side of the chest is felt for a long time, and it will become stronger every time the person moves from rest to physical activity. The condition is treated exclusively surgically, so hospitalization will be required to confirm this diagnosis. Pain in the center of the chest in front can also appear if a pulmonary embolism develops. The pain syndrome becomes stronger on inspiration, and taking analgesics allows you to suppress it. Compressive pain may indicate that a person has angina pectoris, and pain can also be a symptom of myocardial infarction.

Respiratory damage

If there is pain in the front in the center of the chest, and at the same time you feel interruptions in breathing, you cannot breathe deeply, cough and shortness of breath appear, the problem may be the occurrence of pulmonary diseases, which include tracheitis, pneumonia, bronchitis, pleurisy and some others. The same symptoms can occur with diseases of the diaphragm.

Injuries

Pain in front of the chest, in the middle, or between the ribs may occur in a person who has survived an accident, has been involved in a fight, or has damaged chest structures from a fall or blow. Such pains intensify when he tries to turn around, bend down, take a deep breath, and are explained by the fact that blood vessels rupture, the periosteum is damaged, cracks and fractures form. In such a situation, at rest, the pain syndrome can disappear almost completely, which gives a person a false confidence that there is no need to consult a doctor.

Diseases of the spine

The most common reason why the chest hurts in the middle is osteochondrosis, if we talk about the pathologies of the spinal column. Pain in osteochondrosis can be constant or manifest in the form of seizures. The pain will be the same in intensity and manifestation with radiculopathy in the thoracic spine. Also, pain syndrome can indicate an intervertebral hernia and congenital anomalies in the structure of the spinal column.

Neurological diseases

Causes of pain in the chest in the middle can be neuralgic in nature. The most common diagnosis in this case is intercostal neuralgia, in which it is very painful in the sternum, it radiates to the back under the shoulder blade, which makes it easy for a person to confuse pain with heart pain.

Esophageal problems

Pain in the shoulder blades and in the middle of the chest may be associated with pathologies of the esophagus. The reason in this case is, as a rule, a spasm, which manifests itself more often in the morning or after eating. Pain in the chest area is relieved by taking antispasmodic drugs. Often spasms of the esophagus are accompanied by spasm of the muscular walls of the stomach.

How to relieve pain. First Aid

Often a person who has pain in the middle of the chest does not know what to do in such a situation. Some people are in so much pain that they faint. At the same time, a strong fright is observed, the pulse rate increases, the skin turns pale. The first thing to do if suddenly a person has severe pain in the sternum, internal organs and spine:

Remove clothing that restricts the chest, prevents breathing, give a nitroglycerin tablet, which will dilate blood vessels and improve the victim’s condition.

Also, if a person has pain in the middle of the chest, it is best to ask everyone present to leave the room and ensure complete rest for the patient until the ambulance arrives.

Diagnosis

The first thing the doctor will do is to interview and examine the patient, which will narrow the search for pathology by concomitant signs. After that, various diagnostic procedures can be prescribed to determine the cause of the pain syndrome. 9 may be useful0059 magnetic resonance or computed tomography , x-ray , ultrasound , blood tests, etc. This will determine why there are pains in the middle of the chest that radiate to the back, upper limbs or ribs.

Which doctor to contact

If you are able to visit the clinic on your own, you can make an appointment with GP . He will determine the approximate cause of the pain syndrome and the direction of further search, as well as give you directions for diagnostic procedures and, if necessary, to specialized specialists.