What is costochondritis. How is costochondritis diagnosed. What are the symptoms of costochondritis. What causes costochondritis. How is costochondritis treated. What is the outlook for costochondritis. How can costochondritis be prevented.

What is Costochondritis: Demystifying Chest Wall Pain

Costochondritis is a common cause of chest pain that occurs when the cartilage connecting the ribs to the breastbone becomes inflamed. This condition can be alarming due to its similarity to heart attack symptoms, but it’s generally not serious. Understanding costochondritis is crucial for those experiencing unexplained chest discomfort.

The human rib cage consists of 12 pairs of ribs, with the upper 10 pairs typically connected to the sternum (breastbone) by cartilage. This cartilage allows for flexibility during breathing and movement. When this cartilage becomes irritated or inflamed, it results in costochondritis.

Anatomy of Costochondritis

To better understand costochondritis, it’s essential to grasp the anatomy involved:

• Ribs: The skeletal protection for the lungs and chest cavity
• Sternum: The breastbone to which ribs are attached
• Costal cartilage: The flexible tissue connecting ribs to the sternum
• Costochondral junction: The area where the ribs meet the cartilage

When inflammation occurs at these junction points, it leads to the pain and discomfort associated with costochondritis.

Identifying Costochondritis Symptoms: What to Look For

Recognizing the symptoms of costochondritis is crucial for proper diagnosis and treatment. The primary indicator is chest pain, but there are specific characteristics that set it apart from other conditions.

Key Symptoms of Costochondritis

• Sharp, localized pain in the front chest wall
• Pain that may radiate to the back or abdomen
• Increased discomfort when taking deep breaths or coughing
• Tenderness when pressing on the affected area
• Pain relief when resting or breathing shallowly

It’s important to note that costochondritis pain can vary in intensity and duration. Some individuals may experience mild discomfort, while others might feel severe, debilitating pain.

Distinguishing Costochondritis from Other Chest Pain

How can you tell if your chest pain is costochondritis and not something more serious? Here are some distinguishing factors:

1. Location: Costochondritis pain is typically localized to the chest wall
2. Reproducibility: The pain can often be reproduced by pressing on the affected area
3. Breathing impact: Pain usually worsens with deep breathing or coughing
4. Movement: Changing positions may exacerbate or alleviate the pain
5. Duration: Symptoms can last for days or weeks, unlike the persistent pain of a heart attack

While these factors can help differentiate costochondritis, it’s always best to seek medical attention for any unexplained chest pain to rule out more serious conditions.

Causes and Risk Factors: Understanding the Origins of Costochondritis

The exact cause of costochondritis often remains unknown, a condition referred to as idiopathic costochondritis. However, several factors have been identified that may contribute to its development or exacerbate existing inflammation.

Common Triggers for Costochondritis

• Physical trauma to the chest
• Strenuous exercise or heavy lifting
• Severe or persistent coughing
• Viral respiratory infections
• Bacterial infections (rare)
• Certain types of arthritis, such as osteoarthritis or rheumatoid arthritis
• Fibromyalgia
• Poor posture

In some cases, costochondritis may develop as a complication following surgery, particularly chest or cardiac procedures. Additionally, individuals who engage in repetitive arm or chest movements, such as rowers or weightlifters, may be at increased risk.

Risk Factors for Developing Costochondritis

While costochondritis can affect anyone, certain factors may increase the likelihood of developing this condition:

1. Age: It’s more common in adults over 40, but can occur at any age
2. Gender: Women are more frequently affected than men
3. Occupation: Jobs involving repetitive upper body movements
4. Medical history: Previous chest injuries or surgeries
5. Underlying conditions: Arthritis, fibromyalgia, or connective tissue disorders

Understanding these risk factors can help individuals take preventive measures and seek early treatment if symptoms arise.

Diagnosis of Costochondritis: From Symptoms to Confirmation

Diagnosing costochondritis primarily relies on a thorough medical history and physical examination. However, additional tests may be necessary to rule out other potential causes of chest pain.

The Diagnostic Process

1. Medical history: Your healthcare provider will inquire about your symptoms, their duration, and any potential triggers.
2. Physical examination: The doctor will palpate the chest wall to identify areas of tenderness, which is a hallmark of costochondritis.
3. Reproduction of symptoms: Pressing on the affected area should recreate the pain you’ve been experiencing.
4. Exclusion of other conditions: Your provider may order tests to rule out more serious causes of chest pain.

Additional Diagnostic Tests

While not always necessary, the following tests may be ordered to confirm the diagnosis or exclude other conditions:

• Chest X-ray: To rule out lung or heart problems
• Electrocardiogram (ECG): To check for heart-related issues
• Blood tests: To check for signs of infection or inflammation
• CT scan or MRI: In rare cases, to visualize the cartilage and surrounding structures

It’s important to note that costochondritis is often a diagnosis of exclusion, meaning other potential causes of chest pain must be ruled out before confirming costochondritis.

Treatment Options: Managing Costochondritis Pain and Inflammation

The primary goal of costochondritis treatment is to alleviate pain and reduce inflammation. In many cases, the condition resolves on its own within a few weeks to months. However, various treatment options can help manage symptoms and speed up recovery.

Conservative Management

• Rest: Avoiding activities that exacerbate pain
• Hot or cold compresses: Applying heat or ice to the affected area
• Gentle stretching exercises: To improve flexibility and reduce stiffness
• Posture correction: Maintaining good posture to reduce stress on the chest wall

Medications for Costochondritis

Several over-the-counter and prescription medications can help manage costochondritis symptoms:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen or naproxen
2. Acetaminophen: For pain relief without anti-inflammatory effects
3. Topical anti-inflammatory creams: Applied directly to the affected area
4. Oral corticosteroids: In severe cases, prescribed for short-term use
5. Tricyclic antidepressants: Sometimes used for chronic pain management

It’s crucial to consult with a healthcare provider before starting any medication regimen, especially if you have underlying health conditions or are taking other medications.

Physical Therapy and Alternative Treatments

For some individuals, additional therapies may be beneficial:

• Physical therapy: To improve posture and strengthen chest muscles
• Transcutaneous electrical nerve stimulation (TENS): For pain relief
• Acupuncture: May help alleviate pain in some cases
• Chiropractic care: Gentle adjustments to improve rib and spine alignment

While these treatments can be helpful, their effectiveness may vary from person to person. Always consult with your healthcare provider before starting any new treatment regimen.

Prognosis and Long-Term Outlook: What to Expect with Costochondritis

Understanding the prognosis and long-term outlook for costochondritis can help individuals manage their expectations and plan for recovery. While the condition can be uncomfortable and sometimes persistent, it is generally not serious and often resolves with time and appropriate treatment.

Typical Recovery Timeline

The duration of costochondritis symptoms can vary significantly among individuals:

• Acute cases: May resolve within a few days to weeks
• Subacute cases: Can last for several weeks to a few months
• Chronic cases: Symptoms persisting for more than three months

Most people experience improvement within a few weeks with conservative treatment. However, some may have recurring episodes or develop chronic costochondritis.

Factors Affecting Recovery

Several factors can influence the recovery process and overall prognosis:

1. Age: Younger individuals often recover more quickly
2. Overall health: Those with underlying conditions may have a longer recovery
3. Treatment adherence: Following prescribed treatments can speed up recovery
4. Lifestyle modifications: Avoiding triggers and maintaining good posture
5. Stress management: Reducing stress can help alleviate symptoms

It’s important to work closely with your healthcare provider to develop an individualized treatment plan and monitor your progress over time.

Long-Term Management

For those with chronic or recurring costochondritis, long-term management strategies may include:

• Regular exercise and stretching routines
• Ergonomic adjustments at work and home
• Stress reduction techniques, such as meditation or yoga
• Periodic check-ups with a healthcare provider
• Maintaining a healthy weight to reduce stress on the chest wall

By adopting these strategies, individuals can minimize the impact of costochondritis on their daily lives and reduce the likelihood of future flare-ups.

Prevention Strategies: Minimizing the Risk of Costochondritis

While it’s not always possible to prevent costochondritis, certain measures can help reduce the risk of developing this condition or experiencing recurrent episodes. By implementing these preventive strategies, individuals can promote chest wall health and overall well-being.

Lifestyle Modifications

• Proper posture: Maintain good posture to reduce stress on the chest wall
• Ergonomic workspace: Ensure your work environment is ergonomically sound
• Regular exercise: Engage in low-impact activities to strengthen chest muscles
• Warm-up and cool-down: Properly prepare for physical activities
• Stress management: Practice relaxation techniques to reduce overall tension

Injury Prevention

Protecting your chest from injury can help prevent costochondritis:

1. Use proper lifting techniques to avoid strain on the chest
2. Wear protective gear during contact sports or high-risk activities
3. Avoid overexertion during exercise or daily tasks
4. Take breaks during repetitive activities involving the upper body
5. Gradually increase the intensity of workouts to prevent overuse injuries

Health Maintenance

Maintaining overall health can also contribute to preventing costochondritis:

• Stay hydrated to keep connective tissues healthy
• Maintain a balanced diet rich in anti-inflammatory foods
• Get adequate sleep to support tissue repair and overall health
• Manage underlying conditions, such as arthritis or fibromyalgia
• Avoid smoking, which can irritate the respiratory system

By incorporating these preventive measures into daily life, individuals can significantly reduce their risk of developing costochondritis and promote long-term chest wall health.

Understanding costochondritis, its symptoms, causes, and treatment options is crucial for anyone experiencing chest wall pain. While the condition can be uncomfortable and sometimes persistent, it is generally not serious and often resolves with time and appropriate care. By working closely with healthcare providers and adopting preventive strategies, individuals can effectively manage costochondritis and minimize its impact on their quality of life. Remember, any unexplained chest pain should be evaluated by a medical professional to rule out more serious conditions and ensure proper diagnosis and treatment.

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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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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