Costochondritis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Costochondritis is a benign cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connect the ribs to the sternum. Patients often present with chest pain; therefore, other causes of chest pain must be excluded with history and physical exam. If the patient’s history and physical exam warrant additional workup, this should be done before the diagnosis of costochondritis is made. This activity reviews the evaluation, diagnosis, and management of costochondritis and highlights the role of the interprofessional team in the care of affected patients.

Objectives:

• Describe the history and physical exam findings associated with costochondritis.

• Explain how to rule out more grave causes of chest pain prior to diagnosing a patient with costochondritis.

• Describe common treatments for costochondritis.

• Explain the importance of collaboration amongst interprofessional teams when evaluating patients for costochondritis.

Access free multiple choice questions on this topic.

Introduction

Costochondritis is a chest wall pain caused by inflammation of the costal cartilages or the area where the ribs meet the sternum, known as sternal articulations. It is a benign cause of chest pain. Patients often present with the chief complaint of chest pain; therefore, other causes of chest pain must be excluded with history, physical exam, and/or diagnostic testing prior to a diagnosis of costochondritis.

Etiology

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.

Epidemiology

The epidemiology of costochondritis is not well established. In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics. In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%).[1]

History and Physical

As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis. Consider whether the chest pain history is a concerning indicator of acute coronary syndrome, pulmonary embolism, aortic dissection, pneumonia, esophageal injury, pneumothorax, among others. If there was recent trauma or fall, consider an occult rib fracture.

Typically, if chest wall pain is due to costochondritis, the patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath. The pain quality is variable, but it may be described as sharp or dull pain.

If the patient complains of radiating pain, shortness of breath, dizziness, exertional chest pain, fever, productive cough, nausea, etc., these are worrisome for other causes of chest pain. Consider pursuing other causes of chest pain prior to establishing a costochondritis diagnosis.

A good heart and lung exam are important to help build your differential diagnosis when a patient complains of chest pain or chest wall pain. If a patient’s chest wall pain is due to costochondritis, the pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum. One pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible.[2]

Vital signs are also important. Patients with costochondritis should present with normal vital signs. If your patient is tachycardic or hypotensive, this should raise the suspicion of an alternative diagnosis as the cause of your patient’s chest pain. [3]

Evaluation

The purpose of the evaluation is to determine other causes of chest pain. There is not a test to diagnose costochondritis.

Laboratory

Consider a workup for acute coronary syndrome, pneumonia, pulmonary embolism, among others if the patient’s history and physical exam warrant this workup. 

No laboratory evaluation is necessarily required to diagnose costochondritis. It is important to use the laboratory evaluation to evaluate for other diagnoses that are in your differential.

Radiology

A chest x-ray should be considered in all patients with chest wall pain or chest pain to rule out pneumonia, spontaneous pneumothorax, lung mass, among others. 

A normal chest x-ray will be seen with costochondritis.

Other Tests

An electrocardiogram (ECG) should also be considered in all patients with chest wall pain or chest pain to rule out abnormalities associated with infectious causes of chest pain, ischemia, among others.  

A normal electrocardiogram will be seen with costochondritis.[3][4]

Treatment / Management

The treatment for costochondritis is a nonsteroidal anti-inflammatory drug (NSAID).

Some consideration can be given to a course of naproxen or meloxicam because these are dosed twice daily and once daily, respectively. Other NSAIDs can also be used, including ibuprofen. The NSAID of choice is based on provider/patient preference.

NSAIDs are contraindicated in acute and chronic kidney disease.

It is also important to discuss with patients the risk of gastritis with chronic NSAID use. 

If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis.[5][3]

Differential Diagnosis

The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality.

Acute Coronary Syndrome (ACS)

This diagnosis should be considered in any patient presenting with chest pain. If you feel the patient’s history and physical are concerning for ACS, consider an ECG and troponin level to assist in ruling out ACS. The patient should also be on continuous cardiac monitoring while in the emergency department.

Pneumothorax

Consider the patient population at risk for spontaneous pneumothorax. A chest x-ray and/or point-of-care ultrasound (POCUS) can be used to assist in evaluating the possibility of pneumothorax.

Pneumonia

If the patient is complaining of a productive cough and/or fever or is high risk for pneumonia, consider this on your differential diagnosis. Pneumonia can cause chest pain in addition to the other symptoms we associate with the diagnosis. A chest x-ray, complete blood count (CBC), and a basic metabolic panel (BMP) can be helpful when considering this as a differential diagnosis. Vital signs are also important when considering this diagnosis.

Aortic Dissection

This is a medical and possibly a surgical emergency. Consider a CTA to evaluate for aortic dissection if this is a concern based on the patient’s history and physical exam.

Pulmonary Embolism

Ask about pulmonary embolism (PE) risk factors, such as malignancy, recent travel, recent surgery, personal history of PE or deep vein thrombosis (DVT) and symptoms, such as shortness of breath. Tachycardia can also be a sign of a PE. Consider using a clinical decision rule, such as PERC and Well’s criteria when considering PE. A D-dimer and/or CTA can be helpful when evaluating for a PE if this is on your differential diagnosis. There may also be nonspecific ECG and POCUS changes seen.

Esophageal Perforation

The healthcare professional must have a high clinical suspicion for this diagnosis, and it is often due to an iatrogenic cause, such as a recent endoscopy.  This patient’s pain should be severe and unrelenting, and typically, they present in shock with abnormal vital signs.[6]

Prognosis

Costochondritis is a self-limited condition.

Complications

This is a self-limited disease. Patients may present with refractory or recurrent costochondritis. The most important part of the diagnosis of costochondritis is ensuring other, more deadly causes of chest pain have been ruled out.

Deterrence and Patient Education

Educate the patient on proper dosing of NSAIDs and the importance of not taking over-the-counter NSAIDs in addition to the prescription provided.

Educate the patient on return precautions, including worsening chest pain, shortness of breath, dizziness, and syncope.

Pearls and Other Issues

Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality. Patients typically present with chest pain worse with breathing, and it is often positional. It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal. Costochondritis is a self-limited disease. The standard of care is treatment with NSAIDs. Consider ECG and chest x-ray in all patients who present with a chief complaint of chest pain.[6]

Enhancing Healthcare Team Outcomes

Because costochondritis is a diagnosis of exclusion, it can be helpful to involve specialists when ruling out other causes of chest pain. While providers often complete the initial read of the chest x-ray and the ECG, radiology, and cardiology will complete the official reads. It is not uncommon for occult, non-displaced rib fractures to be missed on a chest x-ray following trauma, such as a fall or car accident. If there are any questionable ECG findings, it is prudent to discuss these with a cardiologist or electrophysiologist before diagnosing a patient with costochondritis.

If costochondritis becomes refractory, consider referral to orthopedics and/or physical therapy to assist with treating the patient in an attempt to improve the patient’s pain. Clinicians may also consider referrals to other specialists to evaluate for other causes of chest pain at this time, including gastroenterology and cardiology. There may be a second diagnosis complicating the initial diagnosis of costochondritis.[5][7]

References

1.

Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. 1994 Nov 14;154(21):2466-9. [PubMed: 7979843]

2.

Lanham DA, Taylor AN, Chessell SJ, Lanham JG. Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond). 2015 May;76(5):296-300. [PubMed: 25959942]

3.

Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013 Dec;40(4):863-87, viii. [PubMed: 24209723]

4.

McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 01;87(3):177-82. [PubMed: 23418761]

5.

Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther. 2017 Jun;12(3):458-467. [PMC free article: PMC5455195] [PubMed: 28593100]

6.

King JE, Magdic KS. Chest pain: a time for concern? AACN Adv Crit Care. 2014 Jul-Sep;25(3):279-83. [PubMed: 25054533]

7.

Gologorsky R, Hornik B, Velotta J. Surgical Management of Medically Refractory Tietze Syndrome. Ann Thorac Surg. 2017 Dec;104(6):e443-e445. [PubMed: 29153814]

Costochondritis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Costochondritis is a benign cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connect the ribs to the sternum. Patients often present with chest pain; therefore, other causes of chest pain must be excluded with history and physical exam. If the patient’s history and physical exam warrant additional workup, this should be done before the diagnosis of costochondritis is made. This activity reviews the evaluation, diagnosis, and management of costochondritis and highlights the role of the interprofessional team in the care of affected patients.

Objectives:

• Describe the history and physical exam findings associated with costochondritis.

• Explain how to rule out more grave causes of chest pain prior to diagnosing a patient with costochondritis.

• Describe common treatments for costochondritis.

• Explain the importance of collaboration amongst interprofessional teams when evaluating patients for costochondritis.

Access free multiple choice questions on this topic.

Introduction

Costochondritis is a chest wall pain caused by inflammation of the costal cartilages or the area where the ribs meet the sternum, known as sternal articulations. It is a benign cause of chest pain. Patients often present with the chief complaint of chest pain; therefore, other causes of chest pain must be excluded with history, physical exam, and/or diagnostic testing prior to a diagnosis of costochondritis.

Etiology

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.

Epidemiology

The epidemiology of costochondritis is not well established. In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics. In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%).[1]

History and Physical

As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis. Consider whether the chest pain history is a concerning indicator of acute coronary syndrome, pulmonary embolism, aortic dissection, pneumonia, esophageal injury, pneumothorax, among others. If there was recent trauma or fall, consider an occult rib fracture.

Typically, if chest wall pain is due to costochondritis, the patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath. The pain quality is variable, but it may be described as sharp or dull pain.

If the patient complains of radiating pain, shortness of breath, dizziness, exertional chest pain, fever, productive cough, nausea, etc., these are worrisome for other causes of chest pain. Consider pursuing other causes of chest pain prior to establishing a costochondritis diagnosis.

A good heart and lung exam are important to help build your differential diagnosis when a patient complains of chest pain or chest wall pain. If a patient’s chest wall pain is due to costochondritis, the pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum. One pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible.[2]

Vital signs are also important. Patients with costochondritis should present with normal vital signs. If your patient is tachycardic or hypotensive, this should raise the suspicion of an alternative diagnosis as the cause of your patient’s chest pain.[3]

Evaluation

The purpose of the evaluation is to determine other causes of chest pain. There is not a test to diagnose costochondritis.

Laboratory

Consider a workup for acute coronary syndrome, pneumonia, pulmonary embolism, among others if the patient’s history and physical exam warrant this workup. 

No laboratory evaluation is necessarily required to diagnose costochondritis. It is important to use the laboratory evaluation to evaluate for other diagnoses that are in your differential.

Radiology

A chest x-ray should be considered in all patients with chest wall pain or chest pain to rule out pneumonia, spontaneous pneumothorax, lung mass, among others.  

A normal chest x-ray will be seen with costochondritis.

Other Tests

An electrocardiogram (ECG) should also be considered in all patients with chest wall pain or chest pain to rule out abnormalities associated with infectious causes of chest pain, ischemia, among others. 

A normal electrocardiogram will be seen with costochondritis.[3][4]

Treatment / Management

The treatment for costochondritis is a nonsteroidal anti-inflammatory drug (NSAID).

Some consideration can be given to a course of naproxen or meloxicam because these are dosed twice daily and once daily, respectively. Other NSAIDs can also be used, including ibuprofen. The NSAID of choice is based on provider/patient preference.

NSAIDs are contraindicated in acute and chronic kidney disease.

It is also important to discuss with patients the risk of gastritis with chronic NSAID use. 

If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis.[5][3]

Differential Diagnosis

The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality.

Acute Coronary Syndrome (ACS)

This diagnosis should be considered in any patient presenting with chest pain. If you feel the patient’s history and physical are concerning for ACS, consider an ECG and troponin level to assist in ruling out ACS. The patient should also be on continuous cardiac monitoring while in the emergency department.

Pneumothorax

Consider the patient population at risk for spontaneous pneumothorax. A chest x-ray and/or point-of-care ultrasound (POCUS) can be used to assist in evaluating the possibility of pneumothorax.

Pneumonia

If the patient is complaining of a productive cough and/or fever or is high risk for pneumonia, consider this on your differential diagnosis. Pneumonia can cause chest pain in addition to the other symptoms we associate with the diagnosis. A chest x-ray, complete blood count (CBC), and a basic metabolic panel (BMP) can be helpful when considering this as a differential diagnosis. Vital signs are also important when considering this diagnosis.

Aortic Dissection

This is a medical and possibly a surgical emergency. Consider a CTA to evaluate for aortic dissection if this is a concern based on the patient’s history and physical exam.

Pulmonary Embolism

Ask about pulmonary embolism (PE) risk factors, such as malignancy, recent travel, recent surgery, personal history of PE or deep vein thrombosis (DVT) and symptoms, such as shortness of breath. Tachycardia can also be a sign of a PE. Consider using a clinical decision rule, such as PERC and Well’s criteria when considering PE. A D-dimer and/or CTA can be helpful when evaluating for a PE if this is on your differential diagnosis. There may also be nonspecific ECG and POCUS changes seen.

Esophageal Perforation

The healthcare professional must have a high clinical suspicion for this diagnosis, and it is often due to an iatrogenic cause, such as a recent endoscopy.  This patient’s pain should be severe and unrelenting, and typically, they present in shock with abnormal vital signs.[6]

Prognosis

Costochondritis is a self-limited condition.

Complications

This is a self-limited disease. Patients may present with refractory or recurrent costochondritis. The most important part of the diagnosis of costochondritis is ensuring other, more deadly causes of chest pain have been ruled out.

Deterrence and Patient Education

Educate the patient on proper dosing of NSAIDs and the importance of not taking over-the-counter NSAIDs in addition to the prescription provided.

Educate the patient on return precautions, including worsening chest pain, shortness of breath, dizziness, and syncope.

Pearls and Other Issues

Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality. Patients typically present with chest pain worse with breathing, and it is often positional. It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal. Costochondritis is a self-limited disease. The standard of care is treatment with NSAIDs. Consider ECG and chest x-ray in all patients who present with a chief complaint of chest pain.[6]

Enhancing Healthcare Team Outcomes

Because costochondritis is a diagnosis of exclusion, it can be helpful to involve specialists when ruling out other causes of chest pain. While providers often complete the initial read of the chest x-ray and the ECG, radiology, and cardiology will complete the official reads. It is not uncommon for occult, non-displaced rib fractures to be missed on a chest x-ray following trauma, such as a fall or car accident. If there are any questionable ECG findings, it is prudent to discuss these with a cardiologist or electrophysiologist before diagnosing a patient with costochondritis.

If costochondritis becomes refractory, consider referral to orthopedics and/or physical therapy to assist with treating the patient in an attempt to improve the patient’s pain. Clinicians may also consider referrals to other specialists to evaluate for other causes of chest pain at this time, including gastroenterology and cardiology. There may be a second diagnosis complicating the initial diagnosis of costochondritis.[5][7]

References

1.

Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. 1994 Nov 14;154(21):2466-9. [PubMed: 7979843]

2.

Lanham DA, Taylor AN, Chessell SJ, Lanham JG. Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond). 2015 May;76(5):296-300. [PubMed: 25959942]

3.

Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013 Dec;40(4):863-87, viii. [PubMed: 24209723]

4.

McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 01;87(3):177-82. [PubMed: 23418761]

5.

Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther. 2017 Jun;12(3):458-467. [PMC free article: PMC5455195] [PubMed: 28593100]

6.

King JE, Magdic KS. Chest pain: a time for concern? AACN Adv Crit Care. 2014 Jul-Sep;25(3):279-83. [PubMed: 25054533]

7.

Gologorsky R, Hornik B, Velotta J. Surgical Management of Medically Refractory Tietze Syndrome. Ann Thorac Surg. 2017 Dec;104(6):e443-e445. [PubMed: 29153814]

Costochondritis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Costochondritis is a benign cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connect the ribs to the sternum. Patients often present with chest pain; therefore, other causes of chest pain must be excluded with history and physical exam. If the patient’s history and physical exam warrant additional workup, this should be done before the diagnosis of costochondritis is made. This activity reviews the evaluation, diagnosis, and management of costochondritis and highlights the role of the interprofessional team in the care of affected patients.

Objectives:

• Describe the history and physical exam findings associated with costochondritis.

• Explain how to rule out more grave causes of chest pain prior to diagnosing a patient with costochondritis.

• Describe common treatments for costochondritis.

• Explain the importance of collaboration amongst interprofessional teams when evaluating patients for costochondritis.

Access free multiple choice questions on this topic.

Introduction

Costochondritis is a chest wall pain caused by inflammation of the costal cartilages or the area where the ribs meet the sternum, known as sternal articulations. It is a benign cause of chest pain. Patients often present with the chief complaint of chest pain; therefore, other causes of chest pain must be excluded with history, physical exam, and/or diagnostic testing prior to a diagnosis of costochondritis.

Etiology

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.

Epidemiology

The epidemiology of costochondritis is not well established. In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics. In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%).[1]

History and Physical

As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis. Consider whether the chest pain history is a concerning indicator of acute coronary syndrome, pulmonary embolism, aortic dissection, pneumonia, esophageal injury, pneumothorax, among others. If there was recent trauma or fall, consider an occult rib fracture.

Typically, if chest wall pain is due to costochondritis, the patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath. The pain quality is variable, but it may be described as sharp or dull pain.

If the patient complains of radiating pain, shortness of breath, dizziness, exertional chest pain, fever, productive cough, nausea, etc., these are worrisome for other causes of chest pain. Consider pursuing other causes of chest pain prior to establishing a costochondritis diagnosis.

A good heart and lung exam are important to help build your differential diagnosis when a patient complains of chest pain or chest wall pain. If a patient’s chest wall pain is due to costochondritis, the pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum. One pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible.[2]

Vital signs are also important. Patients with costochondritis should present with normal vital signs. If your patient is tachycardic or hypotensive, this should raise the suspicion of an alternative diagnosis as the cause of your patient’s chest pain.[3]

Evaluation

The purpose of the evaluation is to determine other causes of chest pain. There is not a test to diagnose costochondritis.

Laboratory

Consider a workup for acute coronary syndrome, pneumonia, pulmonary embolism, among others if the patient’s history and physical exam warrant this workup. 

No laboratory evaluation is necessarily required to diagnose costochondritis. It is important to use the laboratory evaluation to evaluate for other diagnoses that are in your differential.

Radiology

A chest x-ray should be considered in all patients with chest wall pain or chest pain to rule out pneumonia, spontaneous pneumothorax, lung mass, among others. 

A normal chest x-ray will be seen with costochondritis.

Other Tests

An electrocardiogram (ECG) should also be considered in all patients with chest wall pain or chest pain to rule out abnormalities associated with infectious causes of chest pain, ischemia, among others. 

A normal electrocardiogram will be seen with costochondritis.[3][4]

Treatment / Management

The treatment for costochondritis is a nonsteroidal anti-inflammatory drug (NSAID).

Some consideration can be given to a course of naproxen or meloxicam because these are dosed twice daily and once daily, respectively. Other NSAIDs can also be used, including ibuprofen. The NSAID of choice is based on provider/patient preference.

NSAIDs are contraindicated in acute and chronic kidney disease.

It is also important to discuss with patients the risk of gastritis with chronic NSAID use. 

If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis.[5][3]

Differential Diagnosis

The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality.

Acute Coronary Syndrome (ACS)

This diagnosis should be considered in any patient presenting with chest pain. If you feel the patient’s history and physical are concerning for ACS, consider an ECG and troponin level to assist in ruling out ACS. The patient should also be on continuous cardiac monitoring while in the emergency department.

Pneumothorax

Consider the patient population at risk for spontaneous pneumothorax. A chest x-ray and/or point-of-care ultrasound (POCUS) can be used to assist in evaluating the possibility of pneumothorax.

Pneumonia

If the patient is complaining of a productive cough and/or fever or is high risk for pneumonia, consider this on your differential diagnosis. Pneumonia can cause chest pain in addition to the other symptoms we associate with the diagnosis. A chest x-ray, complete blood count (CBC), and a basic metabolic panel (BMP) can be helpful when considering this as a differential diagnosis. Vital signs are also important when considering this diagnosis.

Aortic Dissection

This is a medical and possibly a surgical emergency. Consider a CTA to evaluate for aortic dissection if this is a concern based on the patient’s history and physical exam.

Pulmonary Embolism

Ask about pulmonary embolism (PE) risk factors, such as malignancy, recent travel, recent surgery, personal history of PE or deep vein thrombosis (DVT) and symptoms, such as shortness of breath. Tachycardia can also be a sign of a PE. Consider using a clinical decision rule, such as PERC and Well’s criteria when considering PE. A D-dimer and/or CTA can be helpful when evaluating for a PE if this is on your differential diagnosis. There may also be nonspecific ECG and POCUS changes seen.

Esophageal Perforation

The healthcare professional must have a high clinical suspicion for this diagnosis, and it is often due to an iatrogenic cause, such as a recent endoscopy.  This patient’s pain should be severe and unrelenting, and typically, they present in shock with abnormal vital signs.[6]

Prognosis

Costochondritis is a self-limited condition.

Complications

This is a self-limited disease. Patients may present with refractory or recurrent costochondritis. The most important part of the diagnosis of costochondritis is ensuring other, more deadly causes of chest pain have been ruled out.

Deterrence and Patient Education

Educate the patient on proper dosing of NSAIDs and the importance of not taking over-the-counter NSAIDs in addition to the prescription provided.

Educate the patient on return precautions, including worsening chest pain, shortness of breath, dizziness, and syncope.

Pearls and Other Issues

Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality. Patients typically present with chest pain worse with breathing, and it is often positional. It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal. Costochondritis is a self-limited disease. The standard of care is treatment with NSAIDs. Consider ECG and chest x-ray in all patients who present with a chief complaint of chest pain.[6]

Enhancing Healthcare Team Outcomes

Because costochondritis is a diagnosis of exclusion, it can be helpful to involve specialists when ruling out other causes of chest pain. While providers often complete the initial read of the chest x-ray and the ECG, radiology, and cardiology will complete the official reads. It is not uncommon for occult, non-displaced rib fractures to be missed on a chest x-ray following trauma, such as a fall or car accident. If there are any questionable ECG findings, it is prudent to discuss these with a cardiologist or electrophysiologist before diagnosing a patient with costochondritis.

If costochondritis becomes refractory, consider referral to orthopedics and/or physical therapy to assist with treating the patient in an attempt to improve the patient’s pain. Clinicians may also consider referrals to other specialists to evaluate for other causes of chest pain at this time, including gastroenterology and cardiology. There may be a second diagnosis complicating the initial diagnosis of costochondritis.[5][7]

References

1.

Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. 1994 Nov 14;154(21):2466-9. [PubMed: 7979843]

2.

Lanham DA, Taylor AN, Chessell SJ, Lanham JG. Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond). 2015 May;76(5):296-300. [PubMed: 25959942]

3.

Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013 Dec;40(4):863-87, viii. [PubMed: 24209723]

4.

McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 01;87(3):177-82. [PubMed: 23418761]

5.

Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther. 2017 Jun;12(3):458-467. [PMC free article: PMC5455195] [PubMed: 28593100]

6.

King JE, Magdic KS. Chest pain: a time for concern? AACN Adv Crit Care. 2014 Jul-Sep;25(3):279-83. [PubMed: 25054533]

7.

Gologorsky R, Hornik B, Velotta J. Surgical Management of Medically Refractory Tietze Syndrome. Ann Thorac Surg. 2017 Dec;104(6):e443-e445. [PubMed: 29153814]

Costochondritis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Costochondritis is a benign cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connect the ribs to the sternum. Patients often present with chest pain; therefore, other causes of chest pain must be excluded with history and physical exam. If the patient’s history and physical exam warrant additional workup, this should be done before the diagnosis of costochondritis is made. This activity reviews the evaluation, diagnosis, and management of costochondritis and highlights the role of the interprofessional team in the care of affected patients.

Objectives:

• Describe the history and physical exam findings associated with costochondritis.

• Explain how to rule out more grave causes of chest pain prior to diagnosing a patient with costochondritis.

• Describe common treatments for costochondritis.

• Explain the importance of collaboration amongst interprofessional teams when evaluating patients for costochondritis.

Access free multiple choice questions on this topic.

Introduction

Costochondritis is a chest wall pain caused by inflammation of the costal cartilages or the area where the ribs meet the sternum, known as sternal articulations. It is a benign cause of chest pain. Patients often present with the chief complaint of chest pain; therefore, other causes of chest pain must be excluded with history, physical exam, and/or diagnostic testing prior to a diagnosis of costochondritis.

Etiology

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.

Epidemiology

The epidemiology of costochondritis is not well established. In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics. In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%).[1]

History and Physical

As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis. Consider whether the chest pain history is a concerning indicator of acute coronary syndrome, pulmonary embolism, aortic dissection, pneumonia, esophageal injury, pneumothorax, among others. If there was recent trauma or fall, consider an occult rib fracture.

Typically, if chest wall pain is due to costochondritis, the patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath. The pain quality is variable, but it may be described as sharp or dull pain.

If the patient complains of radiating pain, shortness of breath, dizziness, exertional chest pain, fever, productive cough, nausea, etc., these are worrisome for other causes of chest pain. Consider pursuing other causes of chest pain prior to establishing a costochondritis diagnosis.

A good heart and lung exam are important to help build your differential diagnosis when a patient complains of chest pain or chest wall pain. If a patient’s chest wall pain is due to costochondritis, the pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum. One pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible.[2]

Vital signs are also important. Patients with costochondritis should present with normal vital signs. If your patient is tachycardic or hypotensive, this should raise the suspicion of an alternative diagnosis as the cause of your patient’s chest pain.[3]

Evaluation

The purpose of the evaluation is to determine other causes of chest pain. There is not a test to diagnose costochondritis.

Laboratory

Consider a workup for acute coronary syndrome, pneumonia, pulmonary embolism, among others if the patient’s history and physical exam warrant this workup. 

No laboratory evaluation is necessarily required to diagnose costochondritis. It is important to use the laboratory evaluation to evaluate for other diagnoses that are in your differential.

Radiology

A chest x-ray should be considered in all patients with chest wall pain or chest pain to rule out pneumonia, spontaneous pneumothorax, lung mass, among others. 

A normal chest x-ray will be seen with costochondritis.

Other Tests

An electrocardiogram (ECG) should also be considered in all patients with chest wall pain or chest pain to rule out abnormalities associated with infectious causes of chest pain, ischemia, among others. 

A normal electrocardiogram will be seen with costochondritis.[3][4]

Treatment / Management

The treatment for costochondritis is a nonsteroidal anti-inflammatory drug (NSAID).

Some consideration can be given to a course of naproxen or meloxicam because these are dosed twice daily and once daily, respectively. Other NSAIDs can also be used, including ibuprofen. The NSAID of choice is based on provider/patient preference.

NSAIDs are contraindicated in acute and chronic kidney disease.

It is also important to discuss with patients the risk of gastritis with chronic NSAID use. 

If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis.[5][3]

Differential Diagnosis

The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality.

Acute Coronary Syndrome (ACS)

This diagnosis should be considered in any patient presenting with chest pain. If you feel the patient’s history and physical are concerning for ACS, consider an ECG and troponin level to assist in ruling out ACS. The patient should also be on continuous cardiac monitoring while in the emergency department.

Pneumothorax

Consider the patient population at risk for spontaneous pneumothorax. A chest x-ray and/or point-of-care ultrasound (POCUS) can be used to assist in evaluating the possibility of pneumothorax.

Pneumonia

If the patient is complaining of a productive cough and/or fever or is high risk for pneumonia, consider this on your differential diagnosis. Pneumonia can cause chest pain in addition to the other symptoms we associate with the diagnosis. A chest x-ray, complete blood count (CBC), and a basic metabolic panel (BMP) can be helpful when considering this as a differential diagnosis. Vital signs are also important when considering this diagnosis.

Aortic Dissection

This is a medical and possibly a surgical emergency. Consider a CTA to evaluate for aortic dissection if this is a concern based on the patient’s history and physical exam.

Pulmonary Embolism

Ask about pulmonary embolism (PE) risk factors, such as malignancy, recent travel, recent surgery, personal history of PE or deep vein thrombosis (DVT) and symptoms, such as shortness of breath. Tachycardia can also be a sign of a PE. Consider using a clinical decision rule, such as PERC and Well’s criteria when considering PE. A D-dimer and/or CTA can be helpful when evaluating for a PE if this is on your differential diagnosis. There may also be nonspecific ECG and POCUS changes seen.

Esophageal Perforation

The healthcare professional must have a high clinical suspicion for this diagnosis, and it is often due to an iatrogenic cause, such as a recent endoscopy.  This patient’s pain should be severe and unrelenting, and typically, they present in shock with abnormal vital signs.[6]

Prognosis

Costochondritis is a self-limited condition.

Complications

This is a self-limited disease. Patients may present with refractory or recurrent costochondritis. The most important part of the diagnosis of costochondritis is ensuring other, more deadly causes of chest pain have been ruled out.

Deterrence and Patient Education

Educate the patient on proper dosing of NSAIDs and the importance of not taking over-the-counter NSAIDs in addition to the prescription provided.

Educate the patient on return precautions, including worsening chest pain, shortness of breath, dizziness, and syncope.

Pearls and Other Issues

Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality. Patients typically present with chest pain worse with breathing, and it is often positional. It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal. Costochondritis is a self-limited disease. The standard of care is treatment with NSAIDs. Consider ECG and chest x-ray in all patients who present with a chief complaint of chest pain.[6]

Enhancing Healthcare Team Outcomes

Because costochondritis is a diagnosis of exclusion, it can be helpful to involve specialists when ruling out other causes of chest pain. While providers often complete the initial read of the chest x-ray and the ECG, radiology, and cardiology will complete the official reads. It is not uncommon for occult, non-displaced rib fractures to be missed on a chest x-ray following trauma, such as a fall or car accident. If there are any questionable ECG findings, it is prudent to discuss these with a cardiologist or electrophysiologist before diagnosing a patient with costochondritis.

If costochondritis becomes refractory, consider referral to orthopedics and/or physical therapy to assist with treating the patient in an attempt to improve the patient’s pain. Clinicians may also consider referrals to other specialists to evaluate for other causes of chest pain at this time, including gastroenterology and cardiology. There may be a second diagnosis complicating the initial diagnosis of costochondritis.[5][7]

References

1.

Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. 1994 Nov 14;154(21):2466-9. [PubMed: 7979843]

2.

Lanham DA, Taylor AN, Chessell SJ, Lanham JG. Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond). 2015 May;76(5):296-300. [PubMed: 25959942]

3.

Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013 Dec;40(4):863-87, viii. [PubMed: 24209723]

4.

McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 01;87(3):177-82. [PubMed: 23418761]

5.

Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther. 2017 Jun;12(3):458-467. [PMC free article: PMC5455195] [PubMed: 28593100]

6.

King JE, Magdic KS. Chest pain: a time for concern? AACN Adv Crit Care. 2014 Jul-Sep;25(3):279-83. [PubMed: 25054533]

7.

Gologorsky R, Hornik B, Velotta J. Surgical Management of Medically Refractory Tietze Syndrome. Ann Thorac Surg. 2017 Dec;104(6):e443-e445. [PubMed: 29153814]

Costochondritis – Illnesses & conditions

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:

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).

Pulmonary Conditions & Lung Problems in People With Lupus

Dr. Kaner began his presentation by speaking about the challenges physicians face when diagnosing pulmonary issues in people with lupus. There are a large number of different disease processes associated with lupus, which can also cause pulmonary issues, as well as impact treatment. For these reasons, patients with lupus can be among the most complex patients that pulmonologists see.

In his presentation, Dr. Kaner emphasized the importance of partnering with your rheumatologist and pulmonologist to arrive at an accurate diagnosis.

Anatomy of the lung:

When people present with a re-occurring cough, only 50% of the time does it have to do with your lungs. Dr. Kaner spoke with the group about how the lung itself, is not often a cause of specific symptoms, like coughing. The cough, he conveyed, is usually due to the upper nasal track, which can cause a cough as well as other symptoms.

In order to discuss the types of lung problems that someone with SLE may experience, a description of the lung is necessary. The trachea, or windpipe, sits in the back of the throat, and divides into the lungs. The trachea is the beginning of a branching airway formation, Dr. Kaner explained, that then continue to branch out within each lung, growing smaller and smaller until they end. At the end, there is an air-exchanging cavity made up of many alveoli, where blood vessels meet with capillaries. On the surface of the alveoli is a thin membrane which allows the exchange of oxygen with blood vessels outside of the lung. This is how oxygen gets into your blood.

Common Symptoms:

The most common disease symptoms related to the lung that SLE patients notice, Dr. Kaner explained, include:

• chest pain
• cough
• shortness of breath upon exertion

Different approaches are administered by physicians to evaluate each symptom thoroughly. As a lupus patient, one should communicate with your rheumatologist or pulmonologist if you have any of these symptoms.

Common Categories:

Dr. Kaner spoke with the group about the common forms of lung involvement that people with lupus may encounter. These categories include:

Pleuritic Chest Pain:

Pulmonologists approach chest pain by asking questions about where the pain is, how long the pain has been happening, what type of pain it is, and if it stays in one place. Pleuritic chest pain, or pain when you take a breath, is very common in people with SLE. This commonly happens with pain in the chest wall for SLE patients and always in the same location, which can be very easily diagnosed by doctors. This can be due to costochondritis, inflammation of the cartilage that connects the rib to the sternum, and happens more commonly in people who have lupus than the overall population. This, Dr. Kaner stated, can be “exquisitely painful,” but can usually be treated with moist heat and anti-inflammatory drugs.

Upper Respiratory Tract Infections:

Patients with SLE are more likely than most to experience upper respiratory tract infections, due to their immune system being suppressed (including from the use of Steroids or other immune-suppressing medications). These infections, however, can usually be quickly diagnosed with currently available technology. In most cases, Dr. Kaner explained, there is only a need for a nasal swab, which allows the microbiology lab to identify the cause. Due to the different causes, treatment for upper respiratory tract infections depends on what virus or bacteria is causing the infection.

Acute Pneumonitis:

Acute pneumonitis, known as inflammation and/or infection in the lung tissue, can be caused in two different ways.

1) Acute pneumonitis usually caused by a bacterial infection. This can be problematic for people with lupus because the medications that cause immune suppression, such as those used to treat lupus, increase the risk for bacterial infections. This is especially true for the bacteria that don’t generally make people sick but which can cause serious infection problems for those with lupus.

2) Patients with SLE can develop inflammation in their lung that is associated with their lupus. This should be treated with increased suppression of the immune system. Dr. Kaner stressed that, “in order to optimize your treatment with lupus, you really need an accurate diagnosis”. You must work with your doctor towards the correct diagnosis, as the treatments for each cause are entirely different.

Interstitial Lung Disease:

Interstitial lung disease, which is chronic inflammation and scarring of the lung tissue, is generally not curable but it is treatable. This disease occurs when an infection or another substance stays in the alveoli, preventing the exchange of oxygen to the blood. If untreated and worsened, this can lead to a condition called pulmonary fibrosis, scarring of the lung tissue. When a person undergoes a chest CT scan, scarring can be visible within the lung tissue. As this scarring progresses, it can cause structurally misshapen parts, which can lead to additional problems. If the disease has advanced, cysts can form, which can block the view in x-rays making a diagnosis difficult.

Pulmonary Hypertension:

Pulmonary Hypertension can be considered both a cardiovascular and pulmonary problem, because it involves both heart and lung systems. Much like acute pneumonitis, there are two ways in which pulmonary hypertension can develop with someone who has lupus.

1) Pulmonary hypertension involves an increased pressure in the blood vessels inside the lung. When blood goes into the lungs, Dr. Kaner explained, it first goes into the right ventricle, flowing into the pulmonary artery then into the smaller branches that reach the surface of the alveoli. Once the blood has been oxygenated, it then flows back into the left atrium, then to the left ventricle and then delivered to the rest of the body. When there is scarring in the lung, more pressure can be needed for the heart to push the blood from the right ventricle into the lung. This increased pressure is called pulmonary hypertension, related to disease of the lung tissue.

2) Another way for someone to develop pulmonary hypertension with SLE is when the disease directly affects the capillaries in the lung, causing them to no longer allow for maximum blood flow. This is called pulmonary artery hypertension. Dr. Kaner spent a great deal of time discussing this as he said “It is potentially fatal, but incredibly treatable.” Again, this reflects why it is important to have a correct diagnosis as it will determine the mode of treatment for someone with lupus and pulmonary hypertension.

Shrinking Lung Syndrome:

Shrinking lung syndrome is completely unique to SLE, said Dr. Kaner. Shrinking lung syndrome is described as lung volume decreasing over time, resulting in smaller lungs. This reduction in size can then cause shortness of breath. Dr. Kaner emphasized that although this syndrome is very uncommon, but important to diagnose.

Pulmonary Hemorrhage:

Pulmonary hemorrhage, or bleeding in the lung, is a very serious condition that can be life threatening. When there is bleeding in the lung, it eventually blocks the airways, causing one to try to cough it out. This is problematic because if there is too much bleeding and the patient is not able to cough it out fast enough, then the patient can lose the ability to get enough oxygen. Due to this risk, pulmonary hemorrhage is taken very seriously by pulmonologists. For some, as Dr. Kaner explained, the hemorrhage can be very deceptive, resulting in little coughing of blood or no coughing at all.

Diagnostic Tests:

In pulmonary medicine, as Dr. Kaner discussed, the pulmonologist’s history and exam still accounts for 90% of the diagnosis.

To aid in diagnosis, there are often several diagnostic tests that may be recommended by the pulmonologist for someone with lupus. These tests are discussed below:

Chest X-ray

Pulmonary evaluation nearly always begins with a chest x-ray. For problems that are more subtle, if the doctor is not able to see what is causing the problem, a CT scan may be ordered. CT scans are done in cross sections of the body so the pulmonologist can view more specific parts of the lung more clearly.

Chest CT scan (computed tomography)

Chest CT’s with intravenous contrast are often utilized in patients with SLE if they become suddenly short of breath and have chest pain, which could imply a pulmonary embolism. The Chest CT can allow for the doctor to quickly assess if there are any blood clots that have traveled to the lung. Additionally, for interstitial lung disease, a high-resolution chest CT can be performed for further evaluation and diagnosis. This allows for the pulmonologist to see the structure of the lung more clearly.

Pulmonary Function Test

The pulmonary function test is completely non-invasive and can help your doctor follow your lung disease over time, which is very beneficial for people with SLE and lung issues. The most basic test, called Spirometry, measures how much the patient is able to breathe in and out and how fast they are able to do this. The patient exhales into a mouth piece connected to a machine. This can help to initially diagnose and later to monitor the progress of one’s asthma, Chronic Obstructive Pulmonary Disease (COPD), and pulmonary fibrosis. For diagnosis, the pulmonologist finds it useful to graph the flow and volume of the person’s breath so they can see if there is airflow obstruction, as can be seen with COPD with asthma.

The Lung Diffusion Capacity test is similar to Spirometry in that the patient exhales into a mouthpiece. The difference for the Lung Diffusion Capacity is that certain gases, such as a low concentration of carbon monoxide, are used to trace the amount of oxygen that is passed into the blood from the lungs. Through the readings of the carbon monoxide after it has been inhaled and exhaled, the pulmonologist can determine what area for oxygen exchange is available within the lung. This can help detect, diagnose, and measure how much surface area of the lungs are damaged, such as with emphysema or pulmonary fibrosis.

6 Minute walk test

The 6-minute walk test is an evaluation for people who experience shortness of breath. This test involves having the patient walk down a hallway for 6 minutes with an oximeter on. This allows the pulmonologist to see how well the lung saturates the blood with oxygen. This, Dr. Kaner stated, is a very reliable way to look at one’s functional ability.

Bronchoscopy

If the pulmonologist thinks infection may be causing your lung problem, as is a risk in lupus, a bronchoscopy may be advised. This test requires local anesthesia, and is helpful for the diagnosis in people with lupus especially in view of uncommon infections that may occur. The bronchoscopy allows pulmonologists to see into the airways of the lung, and to collect samples for culture and other tests.

Right Heart Catheterization

The Right Heart Catheterization test is an invasive procedure that a pulmonologist may recommend to aid in the diagnosis of pulmonary hypertension. In this procedure a small catheter is guided into the right side of the heart and the artery going to the lung, measuring the blood pressure along the way.

Surgical Lung Biopsy

Another invasive procedure that may be recommended for assistance in diagnosis with pulmonary hypertension or other lung problem is a surgical lung biopsy. This procedure is performed by a thoracic surgeon and is recommended under special circumstances by pulmonologists. The procedure requires the patient to be under general anesthesia. As Dr. Kaner explained, a Surgical Lung Biopsy consists of three holes made in your side, where the surgeon can easily biopsy areas of the lung to gain a better understanding of the cause of the lung problem.

Overall, Dr. Kaner conveyed, people with SLE must work with their rheumatologist and pulmonologist in order to come to the appropriate diagnosis. Afterwards, together with your rheumatologist, your pulmonologist can decide on an appropriate form of treatment.

Visit us online for more information about the SLE Workshop.

Summary completed by Jill Orrock, Masters of Social Work intern and SLE Workshop Coordinator.

Posted: 5/16/2013

Authors

Robert J. Kaner, MD
Associate Attending Physician, NY Presbyterian Hospital
Associate Professor of Clinical Medicine, Weill Cornell Medical College
Associate Professor of Genetic Medicine, Weill Cornell Medical College
Medical Director, Ventilator Management Team, NY Presbyterian Hospital
James P. Smith, M.D. Clinical Scholar, Weill Cornell Medical College

The condition that mimics a heart attack

CHECK-UP:The causes of most cases of costochondritis remain a medical mystery, writes MARION KERR.

WHEN I developed left- sided chest pain and difficulty breathing I was convinced I was having a heart attack. Thankfully, after much investigation I’ve been diagnosed with costochondritis. Can you tell me something about this condition?

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain in the costo-sternal joint – where your ribs and breastbone are joined by rubbery cartilage.

The pain associated with the condition can be sharp, dull or gnawing in nature. Pain associated with costochondritis occurs most often on the left side of your breastbone, though it can occur on either side of your chest.

Other costochondritis symptoms may include pain when taking deep breaths, pain when coughing and difficulty breathing. While the pain experienced with costochondritis pain is often mistaken for heart attack, the pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area.

Heart attack pain may feel as if it’s coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself. Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant. Although the cause of most cases of costochondritis is often unknown, some causes may include injury, infection, fibromyalgia and referred pain from other areas of the body.

When I Googled it I read about something called Tietze syndrome. What’s the difference between it and costochondritis?

The main difference is that when the pain of costochondritis is accompanied by swelling, it’s known as Tietze syndrome.

Now that I’ve got it, apart from taking the medication I was prescribed, is there anything else I can do about it?

The pain of costochondritis usually lasts a week or two and then gradually resolves.

To ease your pain until it fades, your doctor may prescribe a course of non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants or muscle relaxants.

To help relieve the pain, try to avoid activities that make your pain worse. Gentle exercises, such as walking or swimming, can improve your mood and keep your body healthy.

Don’t overdo it, and stop if exercise increases your pain. Apply a heat pad (set on low) to the painful area several times a day. Once your pain is gone, work your way back to your normal activities slowly.

90,000 Seven alarming consequences of coronavirus for the body were identified

On the road to full recovery from COVID-19, many coronavirus patients complain of long-term symptoms and health complications that go far beyond lung disease. As the Turkish Daily Sabah writes, although respiratory symptoms such as coughing and feeling short of breath have been observed among the long-term symptoms in severe cases of COVID-19, doctors are now increasingly reporting broader problems in the body, including in the brain. intestines and heart.

From fatigue, mental fog, and insomnia to heart palpitations, chest pain and muscle pain, this flurry of symptoms, which continues weeks or months after the initial infection, has been dubbed “long covid” by the scientific community. Different countries have different time thresholds for classifying these symptoms, with rates ranging from four to 12 weeks.

They are believed to be associated with the coronavirus, which damages the endothelial cells that line all the blood vessels in our body as it fights our immune system.This damage can disrupt the blood supply to our body, leading to the formation of blood clots, which can cause heart attacks and reduce the flow of blood and oxygen to tissues. COVID-19 can cause a variety of heart problems, including rhythm disturbances in the form of fast or irregular heartbeats, increased heart rate, and inflammation of the muscles and the surrounding muscles. A review in the Journal of the American College of Cardiology found that at least 25% of hospitalized coronavirus patients experienced heart complications.

Although people with preexisting heart and circulatory system diseases are known to have a higher risk of developing complications from COVID-19, otherwise healthy people may also suffer from such long-term effects. In this regard, the adjunct professor and board-certified cardiologist Muhammad Keskin from Istanbul argues that one should not skip examinations after overcoming the disease.

Heart attacks and hypertension often go unnoticed, leading to death when early intervention or timely monitoring could save lives, the specialist says.According to him, COVID-19 “can cause extensive damage to the body. It also takes time for inflammation in the lungs and other parts of the body to subside and go away. You can get rid of the disease, but the consequences will be dire on the body. The damage continues even when the virus is gone. We continue to observe these effects for three months, but we see them more often in people with chronic conditions such as hypertension, obesity, sleep and psychological disorders. ”

Daily Sabah lists seven potential long-term cardiac side effects following COVID-19.

1. Myalgia – or, in other words, muscle pain – is one of the most common side effects of viral diseases. This pain occurs because lactate builds up in muscle tissue while the body fights the virus, directly causing muscle tissue inflammation. While this may lead the patient to think that there is something wrong with the heart, in most cases it is purely muscle pain. But this is not the case with COVID-19. If you’ve ever had the flu, you’ve probably experienced muscle and joint pain.In COVID-19, because spasms and inflammatory reactions are more common in the pectoral muscles, patients are more likely to experience chest pain.

Muhammad Keskin says such muscle problems usually resolve spontaneously and chest pain should go away in two to three weeks. Applying heat, pain relievers, or muscle relaxants will usually solve the problem. This is not a life-threatening situation, the expert said.

2. Tietze’s syndrome – Another cause of chest pain after COVID-19 is Tietze’s syndrome, also known as costochondritis.It occurs as a result of an inflammatory reaction when the ribs are connected to the sternum, and often develops after viral diseases.

According to the observations of Mohammad Keskin in the COVID-19 wards in Turkey, 46% of patients who go to the emergency department with chest pain are caused by diseases of the musculoskeletal system, and one of the most common causes is Tietze syndrome. The chest pain associated with this usually does not go away with exertion and changes with position.Pain is a stabbing sensation. You may also feel an increase in pain when you breathe deeply. But such pain lends itself well to pain relievers. This syndrome is usually short-lived and goes away on its own. In some cases, this can take several months.

3. Myocarditis is an inflammation of the heart muscle that occurs when the immune system gets out of control and damages the muscle in an attempt to destroy the virus. A COVID-19 patient with myocarditis has three options:

a) The heart is completely healed;

b) Heart failure becomes chronic;

c) The patient develops sudden heart failure, which leads to death.

In this disease, unfortunately, chest pain does not fall into a certain category, writes Daily Sabah. It can be tingling, stabbing pains, or pressure and burning, like a typical heart attack. This condition is vital and may require an electrocardiogram (ECG), echocardiogram, or MRI of the heart to diagnose.

4. Pericarditis – inflammation of the pericardium or cardiac membrane. This disease also occurs as a side effect of the war with the virus.Sometimes the virus can directly infect the pericardium. The most common sign of pericarditis is usually severe chest pain, described as sharp and stabbing. The pain is more intense when coughing, swallowing, breathing deeply, or lying down. The pain may decrease slightly when you sit or lean forward. When treating sudden (acute) pericarditis, anti-inflammatory and pain relievers may be needed.

“What scares us about COVID-19-related pericarditis is the sudden increase in pericardial fluid that puts pressure on the heart and impairs heart function.We call this situation pericardial tamponade, ”says Muhammad Keskin. This situation requires urgent intervention. A catheter is inserted through the chest wall into the tissue around the heart to drain excess fluid. Early treatment gives a good response and positive clinical results.

5. Coronary artery thrombosis – clots can also form in the heart vessels after severe cases of COVID-19. Although asymptomatic until significant construction appears, patients often report crushing chest pain, a feeling of heaviness in the heart, dizziness, and shortness of breath.

One of the side effects of the coronavirus is its tendency to cause blood clots to form in all the vessels of the body. If this coagulation occurs in the heart vessels and restricts blood flow to the heart, it can damage heart tissue or cause a sudden heart attack.

6. Heart attack – heart attacks after COVID-19 can also occur due to rupture of plaque in the vessels of the heart, which subsequently leads to occlusion of the arteries. But it is usually seen in people with cardiovascular disease, with smoking, diabetes, high blood pressure and obesity being the main risk factors.

Unlike heart attacks caused by blood clots, plaques or fatty deposits that have formed in the veins over the years and have already partially narrowed the vessel, rupture and completely block the vessel due to infection. This narrowing or blockage causes pain called angina.

Chest pain caused by a heart attack is often a feeling of pressure, burning, and squeezing in the middle of the chest and can spread to the chin, left arm, and back. As soon as you feel such pain, you need to contact a doctor.Time matters here.

Muhammad Keskin states that in the event of a heart attack, the first two hours are vital, and if a clogged blood vessel cannot be opened during this period of time, the damage is usually irreversible and the risk of death increases.

7. Pleurisy – Patients who develop pneumonia due to COVID-19 may experience chest pain and, more often, in the lateral sides of the abdomen due to damage to lung tissue or accumulation of fluid in the pleura, tissue that protects and softens the lungs.

This type of pain is usually caused by damage to the lung from the coronavirus. Pleurisy is characterized by pain in the side (or pain in the side of the abdomen) and a tingling / stitching sensation when breathing, as well as tightness or shortness of breath. As the disease begins to improve, this pain will gradually subside. Usually no special treatment is required.

90,000 Pain in the left side of the ribs

No assessment yet.

A reader asks questions about pain on the left side of the ribs. The doctor thought it was due to stomach acid, but did not have an antacid effect. What is the diagnosis? The pain extends about 5 centimeters below the nipple on the left side towards the sternum and also “across” the back. Good question, the answer is that we would like to help you move forward with your investigation. Feel free to contact us through our facebook Page if you have any questions or requests.

We recommend that everyone interested in this topic read the main articles: – Pain in the ribs

Forest: – Review article: Pain in the ribs

Here is the question the reader asked us and our answer to that question is:

Female (33 years old) : Hello! My roommate is 42 years old with severe abdominal pain (abdominal area).He says it looks like muscle pain in the ribs. So far have been to the doctor who examined and he got Somak when she thought it was stomach acid. After that, the pain intensified. The pain began while eating, but now it is felt constantly when he is sitting, and also periodically when he is standing. When he lies down, the pain disappears. There was something similar 8-9 years ago + radiation in the back. He then went to a chiropractor for almost 1 year with a mild effect. Then he started taking VitaePro, after which the pain disappeared.Since then, he has been involved with VitaePro, trying to double the dose, but now to no avail. The worst is when he comes home from work. Can you help us? Thank you in advance.

Answer: First of all – do not double the dose of the medicine without consulting your doctor if it is safe or safe to do so.

We have some additional questions here.

1) Given that the pain disappears when you lie down, there is a hint that it is stomach acid, esophagus, or the like.

2) Does his back hurt this time too?

3) Could you be a little more specific about where the pain is?

4) Does he have night pain?

5) Is he feeling sick or sick? If so, was there vomiting?

We will be happy to help you in the future.

Mvh
Nikolay V Vondt.net

Woman (33 years old) Thank you very much for your answer on Saturday!

1.) He was on gastroscopy about 10 years ago, found that the esophagus is slightly open. Sour vomiting is not a big problem, and sour vomiting is rare. He now drinks about 0.5 liters of milk every night, sometimes brown. Previously, there was 1 liter of milk and 0.5 kg of cheese per week every day.

2) No, he has no back pain now.

3) Pain on the left side, about 5 cm below the nipple.

4) No, never hurt at night.

5) He feels bad when the pain gets worse.No vomiting or nausea. Especially after the end of the working day, the pain becomes severe.

If it extends very far to the left + bumps into a rib with its belly / sideways, it hurts incredibly. On weekends, when he does not load the body as much, the pain is moderate compared to the work week.

Les også: – 8 exercises for back pain

Answer: Based on the location of the pain (approximately 6 – 7th rib), and that it is more painful to move (to the left), it seems that this is a problem of the musculoskeletal system – that is, this is irritation of the intercostal muscles ( rib muscles between ribs + iliocostalis thoracis) and associated rib attachments.

Because the problem seems so serious in nature, it can develop into so-called costochondritis / Tietze’s syndrome. The pain may worsen with deep breathing and hard physical work. Does this concern your roommate?
Mvh
Nicholas V Vondt.net

Woman (33 years old) : It sounded the same as his! But with deep breathing, the pain does not worsen. After hard physical work, it is worse, but he notices it well at work.Read about Tietze’s syndrome and it goes very well with the symptoms he has.

Answer: Yes, this is probably what he has. Here, it may have to do with anti-inflammatory drugs prescribed by your GP. Physical treatment of the back and muscles may also be relevant if it contributes to dysfunction of the chest.
Mvh
Nicholas V Vondt.net

Woman (33 years old) : It sounded the same as his! But with deep breathing, the pain does not worsen.After hard physical work, it is worse, but he notices it well at work.

then : Hello and thank you very much for the diagnosis to my husband, he received the anti-inflammatory treatment with Voltaren and was totally good. Fantastic!

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Costochondritis – symptoms, causes, tests and treatments for Costochondritis

Costochondritis Review

Costochondritis – inflammation of the joints where the upper ribs connect to the cartilage that holds them to the sternum or sternum. This condition causes localized chest pain, which you can reproduce by pressing on the cartilage in the front of your chest.Costochondritis is relatively harmless and usually resolves without treatment. The cause is usually unknown, but it can be due to increased hand activity.

• Costochondritis (with unknown cause) is a common cause of chest pain in children and adolescents. It accounts for 10% to 30% of all chest pain in children. Every year, doctors estimate about 650,000 cases of chest pain in young people between the ages of 10 and 21. The peak age for this disease is 12-14 years.
• Costochondritis is also considered a possible diagnosis for adults suffering from chest pain. Chest pain in adults is considered a potentially serious symptom of heart problems by most doctors until proven otherwise. Chest pain in adults usually results in a series of tests to rule out heart attacks and heart disease. If these tests are normal and your physical examination matches costochondritis, your doctor will diagnose costochondritis as the cause of chest pain. However, it is important that adults with chest pain are evaluated and screened for cardiovascular disease before they are diagnosed with costochondritis.It is often difficult to distinguish between the two without further testing. The condition affects women more than men (70% versus 30%). Costochondritis can also result from an infection or complication of sternum surgery.
• Tietze’s syndrome is often referred to as costochondritis, but the two conditions are different. You can tell the difference by noting the following:
  • Tietze syndrome is rare.
  • This usually happens suddenly, with chest pain that extends to the arms or shoulder and lasts several weeks.
  • Tietze syndrome is accompanied by localized edema in the painful area (the junction of the ribs and sternum).

Costochondritis Causes

Costochondritis is an inflammatory process, but usually does not have a specific cause. Repeated minor trauma to the chest wall, overuse of the hands, or viral respiratory infections can usually cause chest pain due to costochondritis. Rarely, costochondritis from bacterial infections can occur in people who use intravenous drugs or have had surgery on their upper chest.After surgery, the cartilage may become more prone to infection due to decreased blood flow to the area where it was operated.

Various types of infectious diseases can cause costochondritis.

• Viral: Costochondritis usually occurs with viral respiratory infections due to inflammation of the area from the viral infection itself or from the strain of coughing.
• Bacterial: Costochondritis can occur after surgery and be caused by bacterial infections.
• Fungus: Fungal infections are rare causes of costochondritis.

continued

Costochondrit Symptoms

Chest pain associated with costochondritis usually precedes exercise, minor trauma, or upper respiratory infection.

• Pain, which may be dull, will usually be acute and localized to the anterior chest wall. It can spread to the back or abdomen and is more common on the left side.
• There may be pain with deep breaths or coughing.
• The most common areas of pain are your fourth, fifth, and sixth ribs. This pain is aggravated by movement of the trunk or deep breaths. Conversely, it decreases when your movement stops or when you breathe calmly.
• The reproducible tenderness you feel when you press on the ribs (the stubby joints) is a consistent feature of costochondritis. Without this tenderness, the diagnosis of costochondritis is unlikely.
  
  • Tietze syndrome, on the other hand, presents with swelling at the junction of the rib and cartilage. Costochondritis has no noticeable edema. None of these conditions involve the formation of pus or abscess.
  • Tietze’s syndrome usually affects the joints on the second and third ribs. The swelling can last for several months. The syndrome can develop as a complication of sternum surgery months or years after surgery.
  • When costochondritis occurs as a result of an infection after surgery, you will see redness, swelling, or pus at the site of surgery.

When to seek medical attention

Call your doctor for any of the following symptoms:

• Shortness of breath
• High temperature
• Signs of infection such as redness, pus, and increased rib swelling
• Ongoing or worsening pain despite medication
• Nausea
• sweating
• Dizziness

Go to a hospital emergency department if you have trouble breathing or have any of the following symptoms.These symptoms are not usually associated with costochondritis:

• Fever does not respond to fever medications such as acetaminophen (Tylenol) or ibuprofen (Advil)
• Signs of infection in a tender area such as pus, redness, increased pain and swelling
• Persistent chest pain of any type associated with nausea, sweating, pain in the left arm, or any general chest pain that is poorly localized. These could be signs of a heart attack.If you are unsure what is causing your condition, always go to the emergency room.

continued

Exams and tests for Costochondritis

There is no specific test for the diagnosis of costochondritis. Personal history and physical examination are the basis for diagnosis. However, tests are sometimes used to rule out other conditions that may have similar symptoms but are more dangerous, such as heart disease.

• The clinician will seek to reproduce tenderness in the affected rib joints, usually above the fourth to sixth ribs for costochondritis and above the second to third ribs in Tietze syndrome. With costochondritis with unknown causes, there is no significant swelling of the costochondral joints.
• In Tietze syndrome, the costal-cartilaginous joints are edema and tender. Although some doctors use the terms “cosochondritis” and “Tietze syndrome” interchangeably, Tietze syndrome has a sudden onset without any prior respiratory illness or any history of minor trauma.Radiation pain in the arms and shoulders is common in Tietze syndrome, as well as pain and tenderness associated with swelling in the area that hurts.
• Blood tests and chest x-rays are usually not helpful in diagnosing costochondritis; however, after sternum surgery or for people at risk of cardiovascular disease, doctors are more likely to have tests if you have chest pain and possible costochondritis. to make sure you don’t have an infection or other serious medical problem.To determine if an infection is causing your chest pain, doctors:
  
  • Look for signs of infection such as redness, swelling, pus, and drainage at the surgical site
  • Order a more sophisticated chest scan called a gallium scan that will show an increased uptake of radioactive gallium material in the area of ​​infection
  • Check the white blood cell count to see if it is elevated, a sign of infection
  • Order a chest X-ray if pneumonia is a suspected cause of chest pain
  • Order ECG and other tests if heart problems are suspected
• Costochondritis is a less common cause of chest pain in adults, but is fairly common in people who have had heart surgery.Diagnosis can only be made when more serious causes of chest pain associated with the heart and lungs have been ruled out. Appropriate tests such as EKGs, chest x-rays, blood tests for heart damage, and other tests will be performed as directed. Any chest pain in adults is taken seriously and is not ignored. If you are concerned, check with your doctor.

continued

Costochondritis Treatment

Costochondritis Home Remedies

The following home remedies may provide relief from costochondritis:

• Take pain relievers such as nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve) as needed.
• Using local heat or ice to relieve pain
• Avoid unnecessary exercise or activities that worsen symptoms; avoid contact sports until symptoms improve and then return to normal activities only if appropriate
• Do stretching exercises

Medicines for Costochondritis

• Costochondritis responds to nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil or Motrin) and naproxen (Aleve).
• You may be given a local anesthetic and a steroid injection into an area that is tender if normal activity becomes very painful and the pain does not respond to medication.
• Infectious (bacterial or fungal) costochondritis should be treated first with intravenous (vein or IV) antibiotics. Thereafter, oral or intravenous antibiotics should be continued for another two to three weeks to complete therapy.

Costochondritis Surgery

Surgical removal of inflamed cartilage may be required if there is no response to drug therapy for costochondritis.Your doctor will refer you to a surgeon for consultation if deemed necessary.

Next Steps

Follow-up treatment of cosochondritis

You should see a doctor during your recovery and then once a year. Infectious costochondritis requires long-term follow-up.

Prevention of costochondritis

Since inflammatory costochondritis has no specific cause, there is no good way to prevent it.

Costochondritis prospect

Non-infectious costochondritis will go away on its own, with or without anti-inflammatory treatment.Most people will make a full recovery.

Infectious costochondritis responds well to IV antibiotics and surgery, but recovery may take a long time.

Costochondritis: Prevalence, Symptoms, Causes, Diagnosis and Treatment – Health

Costochondritis is a condition in which chest pain occurs due to inflammation of the cartilage and bones of the chest. Pain with costochondritis occurs as a result of inflammation at the junction of the rib bone and gr

Contents

Costochondritis is a condition in which chest pain occurs due to inflammation of the cartilage and bones of the chest.Costochondritis pain occurs as a result of inflammation at the junction of the rib bone and sternum (sternum). At this point, cartilage joins the bones, which becomes irritated and inflamed.

Depending on the degree of inflammation, costal chondritis can be quite painful. Chest pain will range from mild to severe. Mild causes usually cause chest soreness or some pain when the breast cartilage is touched. Severe costochondritis can cause shooting pain in the arms and chest that is severe enough to affect daily life and does not go away despite treatment.Fortunately, rib chondritis clears up on its own but may require treatment.

Prevalence

The number of people with costochondritis is unknown. One small study from 1994 found costochondritis was more common in women and Hispanics.

A 2015 report in the journal Chest reports the most common causes of chest pain are the musculoskeletal system, with general practice estimates ranging from 21% to 46%.In emergency rooms, the musculoskeletal condition causes chest pains account for 6% of diagnoses of Costochondritis. Support-conditions affect joints, bones and muscles.

Costochondritis can affect both adults and children. One 2009 report at American family physician reported an adolescent outpatient clinic where 31% of adolescents had musculoskeletal pain, with costochondritis accounting for 14% of adolescents who reported chest pain.

Costochondritis is a common diagnosis of acute chest pain in adults.Acute chest pain comes on suddenly and is related to something specific. Eliminating the underlying cause can also stop ribochondritis pain.

Symptoms

Most patients with costocostal chondritis experience pain in the front of the upper chest (sternum) Additional costochondritis pain:

• Often occurs on the left side of the sternum.
• Acute, painful, or similar to pressure
• Will affect more than one rib
• Worse with deep breaths or coughing.
• May radiate to the back or abdomen

Costochondritis pain is usually worse from activity, exercise, or deep inhalation. These actions stretch the inflamed cartilage and touching the affected area can be extremely painful. In addition, due to the large number of nerves that extend from the chest, the pain may also be felt in the shoulders or arms.

Sometimes the symptoms of costochondritis can mimic other conditions, including a heart attack. You should seek immediate medical attention if you experience chest pain that is accompanied by:

• Oppression, fullness, burning, or pressure in the chest
• Burning or pressing pain radiating to the back, neck, jaw, shoulders, or one or both hands
• Pain that lasts more than a few minutes, which increases with physical activity, goes away and returns or changes in intensity.
• Shortness of breath or other breathing problems
• Cold sweats
• Dizziness
• Weak spot
• Nausea or vomiting

The above symptoms may be associated with a heart attack or other heart problem, especially if there are breathing problems and severe pain in the chest. Always seek emergency care for abnormal and debilitating chest pain to avoid possible complications.

Tietze syndrome

A related condition called Tietze syndrome causes pain in one rib (usually the second) and is often accompanied by redness and / or swelling in the most painful areas.The pain can come on suddenly or gradually with Titze and spread to the arms and shoulders. The condition worsens with physical activity, sneezing, or coughing.

Tietze’s syndrome differs from costochondritis in that it causes edema. In addition, Tietze’s pain will go away without any treatment, but the swelling will not go away.

Causes and risk factors

It is often difficult to determine the single cause of ribochondritis. But the conditions that can cause this are:

• Injury to the chest, such as from a blunt blow from a fall or car accident.
• Exercise during heavy lifting or heavy exercise
• Certain viruses or respiratory diseases, including tuberculosis, a severe bacterial infection of the lungs.
• Certain types of inflammatory arthritis
• Tumor in the rib-thoracic joint (the area where the upper ribs meet with the sternum).

People who may be at risk of developing costochondritis, those involved in high-activity sports, physical activity, allergies, frequent irritation, and inflammatory arthritis such as rheumatoid arthritis (RA).

Infection

Costochondritis is sometimes the result of a bacterial infection. These types of chest wall infections are common in people taking intravenous drugs or having surgery on the upper chest. Breast surgeries make the chest wall more susceptible to infections by reducing flooding in that area.

Inflammatory arthritis

Although costochondritis is not as common as inflammatory arthritis, people with RA, ankylosing spondylitis, or psoriatic arthritis are more likely to develop costochondritis.This is because inflammatory arthritis causes inflammation in multiple joints, with the joints in the chest just as susceptible as any other joints in the body.

A study published in the German medical journal, Der Internist , Finds up to 50% of people suffering from chest pain pain that is associated with a musculoskeletal condition. Chest pain associated with inflammatory arthritis affects the bones and muscles of your chest wall (chest wall). In most cases, costochondritis pain in people with inflammatory arthritis is limited and harmless.However, it can sometimes be a sign of a more serious problem that needs treatment.

It is not unusual for people with inflammatory arthritis to have multiple episodes of costochondritis. and most episodes go away without treatment.

Because research shows a strong link between inflammation and heart health, people with inflammatory conditions should inform their doctors about new chest pain. One 2018 report in the journal Current Pharmaceutical Design notes that heart problems in inflammatory joint diseases are common and the leading cause of death in people with inflammatory joint diseases.

How does rheumatoid arthritis increase the risk of heart disease?

Fibromyalgia

Costochondritis chest pain is a common symptom of fibromyalgia. Besides costochondritis and soreness, fibromyalgia is known to cause pain throughout the body, chronic fatigue, problems with concentration and attention, depressed mood, headaches, and more.

If you experience chest pain along with other symptoms of fibromyalgia, talk to your doctor about testing for fibromyalgia.Diagnosing and treating fibromyalgia can eliminate all symptoms, including costochondritis pain, and help improve a person’s quality of life.

Why You May Suffer From Fibromyalgia Chest Pain

Diagnosis

Your doctor or emergency room doctor will perform a physical examination before making a diagnosis. They will ask about symptoms and family history. The doctor will determine the level of pain by pressing on the chest. He or she will also look for signs of inflammation or infection.

X-rays and blood tests will be scheduled to rule out other conditions that may be causing symptoms. Your doctor may also request an electrocardiogram (EKG or EKG) or chest X-ray to look for heart or chest problems.

Treatment

Costochondritis usually clears up on its own, but symptoms may persist for weeks or even months. In general, treatment is aimed at relieving pain.

Costochondritis usually responds well to treatment, including:

• Rest : To reduce inflammation, you should avoid activities that cause pain and aggravate costocostal chondritis.Exercise, deep breathing, and chest muscle tension can increase pain symptoms and slow the healing process. Generally, avoid or limit activities that make your symptoms worse.
• Thermal Applications : Applying hot compresses to the chest may help relieve the symptoms of costochondritis. Apply heat several times a day, especially before activities that may cause irritation. While ice can help with most inflammations, ice can be quite uncomfortable to apply to the chest.
• Anti-inflammatory drugs : Non-steroidal anti-inflammatory drugs (eg Motrin, Advil) help with two aspects of costochondritis. First, they help reduce pain symptoms by making the patient more comfortable. Secondly, these medications help reduce inflammation, which is the main problem. Check with your doctor before taking any anti-inflammatory medications as they may have side effects.

Usually, treatment of inflammation and pain results in costochondritis resolving, but there are cases where costochondritis pain may be chronic.With chronic costochondritis, pain and inflammation return even after proper treatment. Your doctor may prescribe cortisone injections if other treatments have not worked for months.

For chronic costochondritis, you will need long-term treatment to make sure costochondritis does not affect daily activities and quality of life, or treatment specific to an underlying condition such as fibromyalgia or inflammatory arthritis.

A word from Verywell

Chest pain and pressure, including pain in the neck, jaw, buttocks or arm, is a medical emergency even if you have had episodes of costochondritis in the past and especially if you have inflammatory arthritis.Costochondritis or chest wall pain lasting more than three months and significantly affecting your quality of life should also be brought to the attention of your doctor, who can determine the cause and treatment options.

Causes (and complications) of pneumonia

90,000 💊 Costochondritis treatment, symptoms, causes, diagnosis and relief

• Costochondritis Thematic Guide
• Doctor’s Notes on Costochondritis Symptoms

What is Costochondritis?

Picture Costochondritis: Pain and Inflammation

Costochondritis is an inflammation of the joints where the upper ribs connect to the costal cartilage, which attaches them to the sternum (sternum).Costochondritis causes localized chest wall pain and tenderness that can be reproduced by pressing on the involved cartilage in the front of the chest. Costochondritis is a relatively harmless musculoskeletal pain in the chest and usually resolves without treatment. The reason is usually unknown. Costochondritis affects women more often than men (70% versus 30%).

• Costochondritis is a common cause of chest pain in children and adolescents. It accounts for 10% -30% of all chest pain in children.Every year, doctors estimate about 650,000 cases of chest pain in young people between the ages of 10 and 21. The peak age for this condition is 12-14 years old.
• In general, costochondritis is one of the most common causes of musculoskeletal chest pain.
• While chest pain can represent heart disease and heart attack, inflammation around the heart (pericarditis), or lungs (pleurisy), costochondritis is also considered a possible diagnosis in adults with chest pain.
• Tietze syndrome, or Tietze disease, is also a cause of localized musculoskeletal pain in the chest. Tietze’s syndrome is different from the more common costochondritis.
  • Unlike costochondritis, in which there is no edema, Titze’s disease is accompanied by localized edema in the painful area (the junction of the ribs and sternum).

What are

causes of and risk factors for costochondritis?

Costochondritis is an inflammatory process.However, there is usually no specific reason for this. Repeated minor trauma to the chest wall or viral respiratory infections can cause costochondritis. Rarely, costochondritis from bacterial infections can occur in people who use intravenous drugs or have had surgery on their upper chest. Costochondritis can also be a sign of recurrent polychondritis, reactive arthritis, fibromyalgia, and trauma.

Various types of infectious diseases can cause costochondritis, although this is rare.

• Viral: Costochondritis usually occurs with viral respiratory infections due to inflammation of the costochondral joints from the viral infection itself or from coughing.
• Bacterial: Costochondritis can occur after surgery and be caused by bacterial infections.
• Fungus: Fungal infections are rare causes of costochondritis.

Costochondritis can also occur with certain forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, and is sometimes associated with chest pain (sternum pain) in these conditions.Costochondritis can occur in people with fibromyalgia.

What are

Symptoms and Signs of Costochondritis?

• Reproducible tenderness of pressure on the ribbed joints (costochondral joints) is a characteristic feature of costochondritis. Without tenderness, the diagnosis of costochondritis is unlikely.
• Chest pain associated with costochondritis may precede or worsen with exercise, minor trauma, or upper respiratory infection.
• Pain in osteochondritis will usually be acute and localized to the anterior chest wall. It can spread from the chest area to the back or abdomen, causing back or abdominal pain.
• The most common areas of pain are the fourth, fifth, and sixth ribs. This pain is aggravated by movement of the trunk or by deep breathing and therefore can cause breathing problems. Conversely, it decreases when you stop any movement or when breathing calmly.
  • Costochondritis may be misdiagnosed or accompanied by concerns about chest pain.
  • When costochondritis results from infection after surgery (surgery), there may be inflammation with redness, swelling, or pus at the site of the procedure.

When Should Someone Seek Medical Help for Costochondritis?

Call a healthcare professional for any of the following symptoms:

• Shortness of breath
• High temperature
• Signs of infection such as redness, pus, and increased rib swelling
• Ongoing or worsening pain despite taking over-the-counter anti-inflammatory drugs.

Go to a hospital emergency department if you have trouble breathing or have any of the following symptoms. These symptoms are usually not from costochondritis:

• Fever does not respond to fever medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Signs of infection in a tender area such as pus, redness, increased pain and swelling
• Persistent chest pain of any type associated with nausea, sweating, pain in the left arm, or any general chest pain that is not well localized.These symptoms can be signs of a heart attack. If you are not sure what the reason is, always go to the emergency room.

How do doctors diagnose costochondritis?

Costochondritis is diagnosed by history and physical examination, not by special laboratory or imaging tests. Tests are sometimes used to rule out other conditions that may have similar symptoms but are more dangerous, such as heart disease.

• The doctor will try to reproduce tenderness in the affected ribs. There is usually no noticeable visible swelling.
• Blood tests and chest x-rays are usually not helpful in diagnosing costochondritis, but they can be used to rule out other causes of chest pain. However, after sternum surgery or for people at risk of heart disease, doctors are more likely to do tests if there is chest pain and possible costochondritis to make sure there is no infection or other serious medical problem.
  • They will look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery.
  • A more sophisticated chest scan, a gallium scan, can be used to check for infection. This will show an increased uptake of radioactive gallium material in the contaminated area.
  • In situations of possible infection, the white blood cell count may be increased.
  • A chest X-ray is taken if pneumonia is the suspected cause of chest pain.
  • ECG and other tests will be performed if there is a heart problem.

What is medication

treatment for cosochondritis? Are there any home remedies for Costochondritis?

• Treatment for typical costochondritis often includes conservative measures such as topical warming or the application of ice to relieve symptoms.
• Medications to reduce inflammation, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may be helpful.These anti-inflammatory drugs should be taken with food and not for people with stomach problems, ulcers, kidney disease, or blood clotting disorders.
• Avoid unnecessary exercise or activities that worsen symptoms. Avoid contact sports until symptoms improve, then return to normal activities only if you tolerate them

Which healthcare professionals treat Costochondritis?

Physicians who treat costochondritis include general practitioners, including primary care physicians, family physicians and therapists, as well as orthopedists, rheumatologists, and physical therapists.Ancillary healthcare professionals who may be involved in the treatment of costochondritis include physical therapists and massage therapists.

What are Costochondritis medicines?

• Costochondritis can be treated with non-steroidal anti-inflammatory drugs such as ibuprofen (Advil or Motrin) and naproxen (Aleve).
• Costochondritis can be treated with local anesthesia and injection of steroids (such as methylprednisolone or betamethasone) into the sensitive area if normal activity becomes very painful and the pain does not respond to other medications.
• Infectious (bacterial or fungal) costochondritis (rarely) is treated with antibiotics.

What follow-up is needed after treatment for costochondritis?

Physiotherapy is sometimes used in more severe cases of costochondritis. Infectious costochondritis requires careful monitoring to prevent the spread or recurrence of the infection.

Can Costochondritis be prevented?

Since inflammatory costochondritis has no specific cause, there is no real way to prevent it.

What is the prognosis for Costochondritis?

• Non-infectious costochondritis will resolve on its own, with or without anti-inflammatory treatment. Most people will make a full recovery.
• Infectious costochondritis responds well to intravenous (IV) antibiotics and surgical repair.

PAINFUL BREATHING: WHEN TO GET HELP, CAUSES AND TREATMENT AT HOME – LUNGISM

Painful breathing is the discomfort that occurs when inhaling or exhaling.Infections, musculoskeletal injuries, and heart problems can cause this pain.

There are no pain receptors in the lungs, therefore, during painful breathing, it is not the lungs themselves that hurt. However, conditions that affect the lungs, organs, joints, or muscles in the chest cavity can cause pain when breathing.

In this article, we will discuss when to seek help and the possible causes of painful breathing. We also deal with diagnostics, home treatment and prevention.

When to Seek Help

Anyone experiencing excessive sweating along with painful breathing should seek immediate medical attention.

Breathing pain can sometimes be a sign of a potentially life-threatening condition, such as heart attack or pulmonary embolism.

Get immediate medical attention if pain accompanies any of the following:

• choking
• loss or decrease in consciousness
• chest tightness or pain, especially if it extends to the arms, back, shoulder, neck, or jaw
• severe shortness of breath
• blue skin, fingers or nails
• struggling or choking
• excessive sweating
• sudden dizziness or feeling lightheaded

Pneumonia

Pneumonia is an inflammation of the air sacs in the lungs.The most common cause of pneumonia in adults is a bacterial infection, but other causes include viral and fungal infections.

People with pneumonia often experience chest pain, which can be aggravated by inhalation.

Other symptoms of pneumonia may include:

• coughing
• fever
• fatigue
• shortness of breath

People with symptoms of pneumonia should see a doctor. Treatment depends on the cause and severity of the condition.Your doctor may prescribe antibiotics for bacterial infections.

Pleurisy

Pleurisy is an inflammation of the pleura, the tissue that lines the chest cavity and the outside of the lungs. Many conditions can lead to pleurisy, including viral and bacterial infections.

People with pleurisy usually experience severe pain when breathing. Other symptoms may include:

• pain that may extend to the shoulder blades
• chest pain that worsens with coughing or sneezing
• shortness of breath
• unexplained weight loss

People with pleurisy symptoms should see a doctor.Treatment depends on the underlying condition.

Costochondritis

Costochondritis is an inflammation of the cartilage that connects the sternum and ribs. The cause of this inflammation is not always clear, but sometimes it can be the result of a chest injury, severe cough, or a respiratory infection.

Costochondritis usually causes severe pain and tenderness in the sternum. People may find this pain spreads to the back and gets worse with deep breathing or coughing.

Costochondritis often clears up on its own, but people should see a doctor if pain interferes with daily activities.

Pneumothorax

Chest pain that worsens with breathing or coughing may be a sign of pneumothorax.

Pneumothorax occurs when air enters the pleural space, which is the space between the chest wall and the lungs. The accumulation of air increases the pressure in the pleural space, which can lead to the collapse of part or all of a person’s lung.

Injury to the chest, damage to the lung, or a complication of lung disease such as emphysema or tuberculosis usually causes pneumothorax.

Pneumothorax can cause chest pain that gets worse when breathing or coughing. Other symptoms may include:

• heart palpitations
• bluish skin or nails
• shortness of breath
• fatigue
• chest tightness
• dilated nostrils

People with symptoms of pneumothorax should see a doctor. To prevent lung collapse, your doctor may need to remove air from the pleural space.

Pericarditis

Pericarditis is an inflammation of the pericardium, which is a fluid-filled sac that surrounds and protects the heart.A wide range of factors can cause pericarditis, including:

• bacterial and viral infections
• trauma or heart surgery
• certain medications
• autoimmune diseases such as rheumatoid arthritis and lupus
• rarely cancer

painful breathing or sharp chest pain that may improve when you sit upright and lean forward. People with pericarditis may also experience:

• fever
• irregular or rapid heartbeat
• shortness of breath
• lightheadedness or dizziness

Anyone with symptoms of pericarditis should seek medical attention.Doctors usually treat pericarditis with anti-inflammatory drugs.

Breast trauma

Injuries to the chest, such as muscle strains, broken ribs, or chest contusion, can cause pain when breathing. This pain can only occur on the side of the injury.

Other symptoms of chest trauma may include:

• bruising or discoloration of the skin
• pain that spreads to the neck or back
• shortness of breath

Chest trauma may result from:

• Blows and Blows to the Chest
• Sports Injuries
• Severe Cough
• Surgery
• Falls

People with minor chest injuries can often heal themselves at home with sedatives and pain relievers.However, anyone with serious injury or other symptoms should seek medical attention.

Diagnostics

The doctor usually asks the person about their symptoms, reviews their medical history, and performs a physical chest exam.

The doctor may then recommend one or more tests to determine the cause of the pain.

Possible tests include:

• Chest X-ray. An X-ray creates an image of the inside of the chest and allows the doctor to check for injuries and infections.
• Computed tomography. This test involves a series of X-rays taken from different angles to create more accurate images. CT scans are sometimes more useful than chest x-rays.
• Pulmonary function tests. In them, a person performs a series of breath tests that help determine how well their lungs are working. Doctors can use the results to diagnose respiratory conditions such as chronic obstructive pulmonary disease (COPD).
• Electrocardiogram (ECG). Doctors use ECGs to measure the electrical activity of a person’s heart, which can help diagnose heart problems.
• Pulse Oximetry. Pulse oximetry measures the oxygen level in your blood. Low oxygen levels can indicate certain respiratory conditions, such as pneumothorax or pneumonia.

Home treatment

Treatment for people with painful breathing depends on the underlying cause. However, home treatment can help relieve chest pain and other symptoms.

People who have pain when breathing can try:

• Pain relievers. Over-the-counter medications such as ibuprofen and paracetamol can help relieve pain in conditions such as costal chondrosis and mild chest injuries.
• Change of positions. Leaning forward or sitting upright can sometimes help relieve chest pain in conditions such as pericarditis.
• Breathe slower. Relaxing the chest and breathing more slowly can help relieve symptoms in some people.
• Cough suppressants. If symptoms also include coughing, taking an over-the-counter cough medicine can help reduce the discomfort.

Prophylaxis

Eating a healthy diet can reduce the risk of certain conditions that cause painful breathing.

It is not always possible to prevent painful breathing. Conditions that can lead to painful breathing do not always have a clear cause, making it difficult for a person to prevent them.

However, certain lifestyle changes can help reduce the risk of infections and other chest problems that can lead to painful breathing.These may include:

• Quitting smoking
• Good hygiene, such as washing your hands regularly
• Getting a yearly flu shot
• Eating a balanced and healthy diet
• Getting regular exercise
• Getting enough sleep

Summary

Painful breathing is not a disease in itself, but is usually a symptom of another condition. Causes can range from mild to severe and can include chest trauma, infection, and inflammation.

People with painful breathing are advised to see a doctor for an examination. Anyone who has chest pain or shortness of breath should seek immediate medical attention.

Chest wall pain: causes, symptoms, diagnosis and treatment options

Chest wall pain or costal chondritis, also called Tietze syndrome, is a condition in which inflammation occurs between the tissues that connect the rib to the sternum (sternum).For some people, this pain can be alarming because it can feel similar to the pain caused by an impending heart attack.

What is costochondritis?

Costochondritis is often caused by a temporary inflammation of the costal cartilage between the ribs and the sternum in the region of the costo-sternum joint. It often causes chest pain that goes away on its own, but until then, it is considered a medical emergency as the symptoms may resemble those of a heart attack.Once cardiac etiology has been ruled out, research into alternative causes of chest pain can begin.

Costochondritis accounts for almost 10–30 percent of all chest pain in children, with the peak occurring at 12–14 years of age. Adults with this form of chest pain tend to be more worrisome because it could potentially be interpreted as a sign of heart problems, prompting doctors to run a series of tests to rule it out. Costochondritis is known to affect women more often than men (70 percent versus 30 percent), and is also the result of an infection or even a complication of sternum surgery.

What are the causes of costochondritis?

There is usually no clear cause for the development of costochondritis, however, this condition can be caused by one of the following factors:

• Trauma: Blunt trauma to the sternum may lead to the development of ribochondritis.
• Physical stress: Costal chondritis can be caused by heavy lifting, exercise, or even a violent cough.
• Arthritis: Conditions such as osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis can lead to chest pain originating from the costo-thoracic joint.
• Joint infection: Infections leading to tuberculosis, syphilis and aspergillosis can affect the costal joint, leading to the diagnosis of costal chondritis.
• Tumors: Cancer can spread from one point in the body to another, such as the chest, thyroid, or lungs. As a result, chest pain may develop in these areas.

• Fibromyalgia: a condition affecting muscles and soft tissues that can manifest as pain in the chest wall and chest wall.

  Pulmonary embolism: due to a blood clot that travels from other parts of the body and gets stuck in the lungs, obstructing blood flow. This is life –

• a threatening condition manifested by chest pain.
• Pneumonia: Usually caused by infectious bacteria that cause inflammation of the pleura or the membranes surrounding the lungs. Chest pain, soreness, and aches are often aggravated by inhalation.

Costochondritis symptoms

• Frequently observed symptoms:
• Chest pain: May be dull, but usually acute in nature and isolated from the anterior wall.Sometimes the pain can be given to the back or abdomen, more often the left side is affected.
• Pain on deep inspiration
• Cough
• Rib pain: most often the fourth, fifth and sixth ribs hurt. The pain usually increases with movement of the trunk or with a deep breath. Patients can often find relief by reducing movement and breathing calmly.
• Soreness: Pressing the costochondral junction (costal joints) often causes pain and is a permanent sign of the costochondral junction.

You should seek medical attention if you experience any of the following symptoms:

• Shortness of breath
• High temperature
• Nausea
• Sweating
• Increasing pain
• Signs of infection (redness, pus and increased swelling in the joints of the ribs)

Chest wall pain (costochondritis) Complications

Ribochondritis pain may be temporary, but if chronic it can be quite debilitating.This pain can come back during physical activity or even daily tasks, so costal chondritis can really negatively affect a person’s quality of life.

First of all, if the pain is persistent, you need to rule out other causes, including heart problems or even pneumonia. If they are ruled out, your doctor may test for fibromyalgia because costochondritis is a common symptom of fibromyalgia.

With fibromyalgia, you experience pain throughout your body, fatigue and inability to rest due to pain, difficulty concentrating or concentrating, feeling depressed, and headaches.

Treatment options and diagnosis of costochondritis

Diagnosis of costochondritis

Serious cases of chest pain will usually be investigated further. A complete examination, including medical history and physical examination, will be done to rule out possible heart causes. This is often the first step in all serious cases of chest pain. This will help provide any additional clues that can be used as evidence before moving on to additional testing.Typically, after life-threatening causes of chest pain have been ruled out and tenderness along the sternum has been identified, rib chondritis can be diagnosed. Additional tests to rule out other conditions may include:

Blood Tests: Looks for heart enzymes in the blood that indicate a previous episode of myocardial infarction (heart attack).

Electrocardiogram (ECG / EKG): This test is used to measure the electrical signals that are produced when the heart beats.Electrodes are attached to the chest at different points to see how well the heart is contracting and if there are any abnormalities. This will be clearly visible on the ECG.

Echocardiogram: The use of sound waves, which are capable of real-time imaging of the heart muscles, can reveal thickened left ventricular muscle tissue, blood flow through the heart at every beat, and other cardiac abnormalities.

Chest X-ray: A simple imaging test that can give doctors an accurate picture of heart size and lung health.

Costochondritis treatment

Typical treatments for costochondritis include anti-inflammatory drugs, physical therapy and, in very serious cases, surgery.

Common treatments include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): A common pain reliever found in many pharmacies and grocery stores. They are designed to reduce pain and swelling. However, long-term use of these drugs can damage the liver and even increase the risk of heart attacks.NSAIDs can also be found in topical solutions and do not pose as much of a risk as oral forms.
• Drugs: are often used for severe pain and can only be prescribed by a physician. These medications include codeine such as hydrocodone / acetaminophen (Vicodin, Norco) or oxycodone / acetaminophen (Tylox, Roxicet, Percocet).
• Other medicines: Amitriptyline, a tricyclic antidepressant, is known to help control unwanted pain.The widely used anticonvulsant drug gabapentin (Neurontin) has also shown some efficacy in treating chronic pain.
• Heat or ice: relieves pain and makes you feel more comfortable.
• Rest: It is recommended to avoid activities that may aggravate ribochondritis pain.

Costochondritis will go away on its own, but if you notice the pain does not go away within a few weeks, seek medical attention.

Any case of chest pain cannot be ignored as it can be difficult to say with certainty that it is caused by a serious or minor cause.