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.

Costochondritis | NHS inform

Costochondritis is the medical term for inflammation of the cartilage that joins your ribs to your breastbone (sternum). This area is known as the costochondral joint.

Cartilage is tough but flexible connective tissue found throughout the body, including in the joints between bones. It acts as a shock absorber, cushioning the joints.

Costochondritis may improve on its own after a few weeks, although it can last for several months or more. The condition doesn’t lead to any permanent problems, but may sometimes relapse.

Tietze’s syndrome

Costochondritis may be confused with a separate condition called Tietze’s syndrome. Both conditions involve inflammation of the costochondral joint and can cause very similar symptoms.

However, Tietze’s syndrome is much less common and often causes chest swelling, which may last after any pain and tenderness has gone.

Costochondritis also tends to affect adults aged 40 or over, whereas Tietze’s syndrome usually affects young adults under 40.

As the conditions are very similar, most of the information below also applies to Tietze’s syndrome.

Signs and symptoms

When the costochondral joint becomes inflamed it can result in sharp chest pain and tenderness, which may develop gradually or start suddenly.

The pain may be made worse by:

• a particular posture – such as lying down
• pressure on your chest – such as wearing a seatbelt or hugging someone
• deep breathing, coughing and sneezing
• physical activity

When to seek medical help

It can be difficult to tell the difference between the chest pain associated with costochondritis and pain caused by more serious conditions, such as a heart attack.

However, a heart attack usually causes more widespread pain and additional symptoms, such as breathlessness, nausea and sweating.

If you, or someone you’re with, experiences sudden chest pain and you think there’s a possibility it could be a heart attack, dial 999 immediately and ask for an ambulance.

If you’ve had chest pain for a while, don’t ignore it. Make an appointment to see your GP so they can investigate the cause.

Causes of costochondritis

Inflammation is the body’s natural response to infection, irritation or injury.

It’s not known exactly why the costochondral joint becomes inflamed, but in some cases it’s been linked to:

• severe coughing – which strains your chest area
• an injury to your chest
• physical strain from repeated exercise or sudden exertion that you’re not used to – such as moving furniture
• an infection – including respiratory tract infections (RTIs) and wound infections
• wear and tear – your chest moves in and out 20 to 30 times a minute, and over time this motion can lead to discomfort in these joints

Diagnosing costochondritis

If you have symptoms of costochondritis, your GP will examine and touch the upper chest area around your costochondral joint. They’ll ask you when and where your pain occurs and look at your recent medical history.

Before a diagnosis can be confirmed, some tests may need to be carried out to rule out other possible causes of your chest pain.

These may include:

• an electrocardiogram (ECG) – which records the rhythms and electrical activity of your heart
• a blood test to check for signs of underlying inflammation
• a chest X-ray

If no other condition is suspected or found, a diagnosis of costrochondritis may be made.

Treating costochondritis

Costochondritis often gets better after a few weeks, but self-help measures and medication can manage the symptoms.

Self-help

Costochondritis can be aggravated by any activity that places stress on your chest area, such as strenuous exercise or even simple movements like reaching up to a high cupboard.

Any activity that makes the pain in your chest area worse should be avoided until the inflammation in your ribs and cartilage has improved.

You may also find it soothing to regularly apply heat to the painful area – for example, using a cloth or flannel that’s been warmed with hot water.

Painkillers

Painkillers, such as paracetamol, can be used to ease mild to moderate pain.

Taking a type of medication called a non-steroidal anti-inflammatory drug (NSAID) – such as ibuprofen and naproxen – two or three times a day can also help control the pain and swelling. 

Aspirin is also a suitable alternative, but shouldn’t be given to children under 16 years old.

These medications are available from pharmacies without a prescription, but you should make sure you carefully read the instructions that come with them before use.

NSAIDs aren’t suitable for people with certain health conditions, including:

• asthma
• stomach ulcers
• high blood pressure
• kidney or heart problems

Contact your GP if your symptoms get worse despite resting and taking painkillers, as you may benefit from treatment with corticosteroids.  

Corticosteroid injections

Corticosteroids are powerful medicines that can help reduce pain and swelling. They can be injected into and around your costochondral joint to help relieve the symptoms of costochondritis.

Corticosteroid injections may be recommended if your pain is severe, or if NSAIDs are unsuitable or ineffective.

They may be given by your GP, or you may need to be referred to a specialist called a rheumatologist.

Having too many corticosteroid injections can damage your costochondral joint, so you may only be able to have this type of treatment once every few months if you continue to experience pain.

Transcutaneous electrical nerve stimulation (TENS)

TENS is a method of pain relief where a mild electric current is delivered to the affected area using a small, battery-operated device. 

The electrical impulses can reduce the pain signals going to the spinal cord and brain, which may help relieve pain and relax muscles.

They may also stimulate the production of endorphins, which are the body’s natural painkillers.

Although TENS may be used to help relieve pain in a wide range of conditions, it doesn’t work for everyone.

There isn’t enough good-quality scientific evidence to say for sure whether TENS is a reliable method of pain relief. Speak to your GP if you’re considering TENS.

Read more about transcutaneous electrical nerve stimulation (TENS).

Costal chondritis (Tietze’s syndrome) | Clinic Hello!

How to diagnose the disorder

It is quite difficult to see Tietze’s syndrome in the photo, just as difficult to diagnose when viewed without palpation. The destruction of the costal cartilage is diagnosed on the basis of the patient’s complaints, palpation, a series of studies (ultrasound, CT, MRI), blood tests. Some types of diagnostics can exclude heart disease and malignant neoplasms.

MRI and biopsy are indicated in cases where it is difficult to make an accurate diagnosis. These methods allow you to exclude the likelihood of malignant tumors. It is also important to distinguish this problem from various rheumatic disorders, intercostal neuralgia.

With Tietze’s syndrome, the patient complains of pain in the chest, next to the sternum. Often, pain is found on one side of the sternum. Pain can be sharp or growing. The pain syndrome lasts for a long time, sometimes for hours. This disease differs from disorders of the cardiac system. The costal cartilages next to the sternum are swollen on examination.

The disease usually affects 1-2 ribs, rarely 3-4. As a rule, the affected cartilages are located on one side of the chest. Floating ribs are not affected by the syndrome – they are not fixed on the sternum. If the pain is not in front, but in the back, then this is not Tietze’s syndrome, but another disease. Which one, you can only find out as a result of a medical examination.

Treatment without hospitalization

To start treatment, you need to be examined by an orthopedic traumatologist. The specialist will accurately diagnose and prescribe therapy. In most cases, we are talking about conservative treatment. The patient does not need to be afraid that he will be admitted to the hospital and will undergo surgical procedures. Treatment takes place on an outpatient basis, at home. For therapy use:

• gels;
• ointments;
• non-steroidal anti-inflammatory drugs;
• compresses;
• painkillers (for severe pain).

If this does not help, they may give injections of novocaine and hydrocortisone directly into the affected area. This should help recovery. As an additional means, physio- and reflexotherapy, manual effects are prescribed.

Usually the cartilage layer is restored, especially if the patient refrains from physical activity, takes vitamin complexes, eats properly. In order to control the condition of the cartilage tissue, it is necessary to regularly visit a doctor and be observed by him. Treatment of the spine and joints requires much more time than Tietze’s syndrome.

However, in some cases, conservative therapy is powerless. In this case, if the drugs did not help, a subperiosteal resection of the rib is prescribed. The procedure is carried out under anesthesia. It is important to note that such situations are indeed very rare.

How to avoid the disease

For successful prevention, it is important to consider that drug addicts, athletes, people after a thoracotomy (opening the chest cavity through the chest wall), as well as everyone who is engaged in heavy physical labor (for example, , movers). Also, the risk increases with chronic and regular injuries of the shoulders and chest, constant stress on this area, metabolic disorders, age-related and hormonal changes.

The problem of prevention is that the exact cause of this disease is unknown. It is recommended to consider all possible causes of its development. It is necessary to avoid serious loads that injure the chest, exercise moderately. People engaged in heavy physical labor will remain at risk until they find another occupation.

It is recommended to pay special attention to the diet. Nutrition should be complete, the body should receive all the necessary vitamins and minerals. It is better to buy high-quality mineral and vitamin complexes. It is imperative to strengthen the immune system, the weakening of which is also associated with the development of Tietze’s syndrome.

Physiotherapy can be done from time to time. After injuries, such additional methods of treatment are definitely recommended – do not neglect them. This is an excellent disease prevention.

If there is pain in the sternum, swelling, feeling of a sliding rib, you should see a doctor as soon as possible. In the early stages, the disease is guaranteed to be cured with the help of conservative therapy. Don’t expect everything to go away on its own. It’s possible, but it’s not worth the risk.

Costal chondritis (Tietze’s syndrome), causes, symptoms and treatment

Costal chondritis (Tietze’s syndrome), causes, symptoms and treatment | Diseases of the musculoskeletal system

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Musculoskeletal system

Costal chondritis (Tietze’s syndrome)

Costal chondritis or Tietze’s syndrome is an inflammation of the costal cartilage, which is characterized by local pain in the chest, aggravated by palpation. Most often, the disease occurs in children aged 12-14 years. It is considered harmless and usually does not require serious treatment. Costal chondritis in adults occurs at the age of 20-40 years and can be a sign of various diseases, therefore, if pain occurs in the sternum, you should consult a doctor and undergo an examination. Tietze’s syndrome is treated by an orthopedist and a traumatologist.

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Symptoms of costal chondritis

Costal chondritis is accompanied by the following symptoms:

• acute pain syndrome in the left side of the chest swelling over the affected rib
• radiating pain in the scapular region, cervical region, collarbone and arm
• respiratory failure

When a secondary infection joins, the inflammatory process aggravates, while the pain bothers the patient for several months or years.

Tietze syndrome pain can be sharp, dull, or aching in nature. By intensity, it is divided into tolerant and pronounced. Pain may occur rarely or disturb a person constantly for many years. In this case, periods of remissions and exacerbations are possible. The general well-being of the patient during the period of exacerbation does not suffer, but because of the pain syndrome, he becomes irritable.

Article checked

Konovalova G. N.

Neurologist • experience 44 years

Date of publication: 24 March 2021

Date of inspection: 09 February 2023

Contents of the article

Causes

Diagnosis

The doctor examines the attachment points of the ribs to the chest not. To detect costal chondritis, a chest x-ray is prescribed. In the picture, the doctor checks the shape of the rib, its hyperplasia, the presence of asymmetric areas of calcification and seals. To exclude diseases of the heart and respiratory system, laboratory tests, electrocardiography, computed tomography and MRI, biopsy to examine tissues under a microscope and exclude malignant lesions are additionally required. They allow you to visualize in detail the initial stages of pathologies.

Which doctor to contact

Candidate of Medical Sciences

Chief Physician of CMRT St. Petersburg

Candidate of Medical Sciences

Chief Physician of CMRT Moscow

Treatment of costal chondritis

Complications

Prevention of costal chondritis

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Article checked

Moskaleva V.V.

Editor • Journalist • Experience 10 years

We publish only verified information

The materials posted on the site are written by authors with medical education and specialists from the CMRT 9 company0005 Read more

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