What is costochondritis. How does it cause rib pain. What are the common symptoms of costochondritis. How is costochondritis diagnosed. What treatments are available for costochondritis. Can costochondritis resolve on its own. What is the outlook for people with costochondritis.

What is Costochondritis and How Does It Affect the Ribs?

Costochondritis is a common cause of chest pain that occurs when the cartilage connecting the ribs to the breastbone becomes inflamed. This condition primarily affects the upper ribs, as all but the lowest two ribs are attached to the sternum by cartilage. Understanding the anatomy of the rib cage is crucial to grasping the nature of costochondritis.

The rib cage serves as a protective structure for vital organs such as the lungs and heart. It consists of 12 pairs of ribs, with the upper seven pairs directly connected to the sternum via cartilage. These connections allow for the expansion and contraction of the chest cavity during breathing, a process that can be disrupted when costochondritis develops.

The Role of Cartilage in Rib Function

Cartilage plays a crucial role in the function of the rib cage. It provides flexibility and cushioning between the ribs and the sternum, allowing for smooth movement during respiration. When this cartilage becomes inflamed in costochondritis, it can lead to significant discomfort and pain in the chest area.

Identifying the Causes of Costochondritis

While the exact cause of costochondritis is often unknown, several factors have been identified as potential triggers for this condition. These include:

• Chest injuries
• Strenuous exercise or heavy lifting
• Viral infections, particularly those affecting the respiratory system
• Persistent coughing, which can strain the chest wall
• Infections following surgery or intravenous drug use
• Certain types of arthritis

Do certain activities or conditions increase the risk of developing costochondritis? Indeed, engaging in high-impact sports, repetitive arm movements, or experiencing respiratory infections can all contribute to the onset of this condition. Additionally, individuals with underlying inflammatory disorders may be more susceptible to costochondritis.

Recognizing the Symptoms of Costochondritis

The hallmark symptoms of costochondritis include pain and tenderness in the chest area. Patients typically experience:

• Sharp pain localized to the front of the chest wall, which may radiate to the back or stomach
• Increased discomfort during deep breathing or coughing
• Tenderness when pressure is applied to the area where the rib joins the breastbone
• Pain relief when movement is minimized and breathing is shallow

How can one differentiate costochondritis pain from other types of chest pain? Unlike the pain associated with heart conditions, costochondritis pain is typically sharper and more localized. It also tends to worsen with movement or pressure on the affected area, whereas cardiac pain is often more diffuse and may be accompanied by other symptoms such as shortness of breath or nausea.

Diagnostic Approaches for Costochondritis

Diagnosing costochondritis involves a combination of medical history assessment and physical examination. The process typically includes:

1. A thorough discussion of symptoms and potential triggers
2. Physical examination focusing on the chest wall, particularly the costal cartilage areas
3. Palpation of the affected region to identify areas of tenderness
4. Possible chest X-rays in cases of severe or persistent symptoms
5. Additional tests to rule out other conditions, such as heart attacks or lung disorders

Why is it important to rule out other serious conditions when diagnosing costochondritis? Given that chest pain can be a symptom of various conditions, including life-threatening cardiac events, it’s crucial to ensure that costochondritis is the correct diagnosis. This often involves a process of elimination and may require additional diagnostic tests to provide a comprehensive assessment of the patient’s health.

Effective Treatment Strategies for Costochondritis

While costochondritis often resolves on its own within a few days to weeks, various treatment options can help manage symptoms and promote recovery:

Conservative Management

• Application of hot or cold compresses to the affected area
• Avoiding activities that exacerbate the pain
• Use of over-the-counter pain relievers such as ibuprofen or naproxen to reduce inflammation and discomfort
• Acetaminophen as an alternative pain management option, particularly for those with contraindications to NSAIDs

Medical Interventions

In cases of severe pain or persistent symptoms, healthcare providers may recommend:

• Prescription-strength pain medications
• Physical therapy to improve chest wall flexibility and strength
• In rare cases, local injections of corticosteroids to reduce inflammation

How long does it typically take for costochondritis to resolve with treatment? While many cases improve within a few weeks, some individuals may experience symptoms for several months. The duration can vary depending on the underlying cause, the severity of inflammation, and the effectiveness of the chosen treatment approach.

Understanding the Prognosis and Long-Term Outlook

The prognosis for costochondritis is generally favorable, with most cases resolving completely without long-term complications. However, the condition can recur in some individuals, particularly those with underlying risk factors or chronic conditions.

Can costochondritis lead to any long-term health issues? While costochondritis itself is not typically associated with serious long-term health problems, chronic or recurrent cases may impact quality of life and daily activities. In rare instances, persistent inflammation could potentially lead to weakening of the costal cartilage, but this is not a common outcome.

Preventive Measures and Lifestyle Modifications

While it may not always be possible to prevent costochondritis, certain measures can help reduce the risk of developing or exacerbating the condition:

• Practicing proper posture and ergonomics, especially during physical activities
• Gradually increasing the intensity of exercise routines to avoid overexertion
• Using appropriate protective gear during contact sports or activities with a high risk of chest injury
• Managing underlying conditions that may contribute to inflammation, such as respiratory infections or autoimmune disorders
• Incorporating stretching and strengthening exercises for the chest and upper body, under the guidance of a healthcare professional

How can individuals with a history of costochondritis minimize the risk of recurrence? Maintaining a balanced approach to physical activity, avoiding sudden increases in exercise intensity, and being mindful of chest-straining movements can help prevent future episodes. Additionally, promptly addressing any respiratory infections or chronic cough can reduce the likelihood of developing costochondritis.

When to Seek Medical Attention for Chest Pain

While costochondritis is often benign, it’s crucial to recognize when chest pain warrants immediate medical evaluation. Individuals should seek prompt medical care if they experience:

• Sudden, severe chest pain
• Chest pain accompanied by shortness of breath, dizziness, or nausea
• Pain that radiates to the jaw, left arm, or back
• Symptoms that worsen rapidly or do not improve with rest
• Fever or other signs of infection in conjunction with chest pain

Why is it essential to err on the side of caution when experiencing chest pain? Given that chest pain can be a symptom of serious cardiac conditions, it’s always better to seek professional medical evaluation to rule out life-threatening causes. Even if the ultimate diagnosis is costochondritis, the peace of mind and proper treatment guidance are invaluable.

Differential Diagnosis Considerations

Healthcare providers must consider several other conditions when evaluating chest pain, including:

• Myocardial infarction (heart attack)
• Angina pectoris
• Pericarditis
• Pneumonia or pleurisy
• Gastroesophageal reflux disease (GERD)
• Thoracic outlet syndrome

How do healthcare professionals distinguish between costochondritis and more serious conditions? A combination of physical examination, patient history, and diagnostic tests helps clinicians differentiate costochondritis from other causes of chest pain. The localized nature of costochondritis pain, its response to palpation, and the absence of other systemic symptoms often point towards this diagnosis.

Living with Costochondritis: Coping Strategies and Support

For individuals dealing with costochondritis, especially in cases where symptoms persist or recur, developing effective coping strategies is crucial. These may include:

• Stress management techniques such as meditation or deep breathing exercises
• Adapting daily activities to minimize strain on the chest wall
• Using supportive pillows or cushions to maintain comfortable postures
• Engaging in gentle stretching exercises as recommended by a healthcare provider
• Joining support groups or online communities for individuals with chronic pain conditions

How can family members and caregivers support someone with costochondritis? Understanding the nature of the condition, offering emotional support, and assisting with tasks that may exacerbate symptoms can significantly improve the quality of life for those affected by costochondritis. Encouraging adherence to treatment plans and providing a supportive environment for recovery are also essential aspects of care.

The Importance of Patient Education

Educating patients about costochondritis plays a vital role in managing the condition effectively. Key points to emphasize include:

• The typically benign nature of the condition
• The importance of adhering to treatment recommendations
• Recognizing triggers that may exacerbate symptoms
• Understanding when to seek additional medical attention
• The role of self-care in managing and preventing recurrences

Why is patient education particularly crucial in managing costochondritis? Empowering patients with knowledge about their condition can reduce anxiety, improve compliance with treatment plans, and enable individuals to take an active role in their recovery process. This informed approach often leads to better outcomes and a quicker return to normal activities.

Emerging Research and Future Directions in Costochondritis Management

While costochondritis is a well-recognized condition, ongoing research continues to explore new avenues for diagnosis and treatment. Some areas of current interest include:

• Advanced imaging techniques for more accurate diagnosis
• Novel anti-inflammatory medications with fewer side effects
• The potential role of regenerative medicine in treating chronic cases
• Investigating genetic factors that may predispose individuals to costochondritis
• Developing targeted physical therapy protocols for prevention and treatment

How might future advancements change the landscape of costochondritis management? As our understanding of the condition grows, we may see more personalized treatment approaches, improved diagnostic tools that can detect costochondritis earlier, and potentially even preventive strategies for high-risk individuals. These advancements could significantly improve outcomes and quality of life for those affected by this common but often challenging condition.

The Role of Interdisciplinary Care

Recognizing the complex nature of chest pain and the potential impact of costochondritis on overall well-being, an interdisciplinary approach to care is increasingly valued. This may involve collaboration between:

• Primary care physicians
• Rheumatologists
• Pain management specialists
• Physical therapists
• Mental health professionals

Why is an interdisciplinary approach beneficial in managing costochondritis? By addressing the condition from multiple perspectives, healthcare teams can provide more comprehensive care, addressing not only the physical symptoms but also the potential psychological and functional impacts of chronic or recurrent chest pain. This holistic approach often leads to better overall outcomes and improved patient satisfaction.

Costochondritis Information | Mount Sinai

Chest wall pain; Costosternal syndrome; Costosternal chondrodynia; Chest pain – costochondritis

All but your lowest 2 ribs are connected to your breastbone by cartilage. This cartilage can become inflamed and cause pain. This condition is called costochondritis. It is a common cause of chest pain.

The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

Causes

There is often no known cause of costochondritis. But it may be caused by:

• Chest injury
• Hard exercise or heavy lifting
• Viral infections, such as respiratory infections
• Strain from coughing
• Infections after surgery or from IV drug use
• Some types of arthritis

Symptoms

The most common symptoms of costochondritis are pain and tenderness in the chest. You may feel:

• Sharp pain at the front of your chest wall, which may move to your back or stomach
• Increased pain when you take a deep breath or cough
• Tenderness when you press the area where the rib joins the breastbone
• Less pain when you stop moving and breathe quietly

Exams and Tests

Your health care provider will take your medical history and do a physical exam. The area where the ribs meet the breastbone is checked. If this area is tender and sore, costochondritis is the most likely cause of your chest pain.

A chest x-ray may be done if your symptoms are severe or do not improve with treatment.

Your provider may also order tests to rule out other conditions, such as a heart attack.

Treatment

Costochondritis most often goes away on its own in a few days or weeks. It can also take up to a few months. Treatment focuses on relieving the pain.

• Apply hot or cold compresses.
• Avoid activities that make the pain worse.

Pain medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may help to ease pain and swelling. You can buy these without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Take the dose as advised by the provider. Do not take more than the amount recommended on the bottle. Carefully read the warnings on the label before taking any medicine.

You may also take acetaminophen (Tylenol) instead, if your provider tells you it is safe to do so. People with liver disease should not take this medicine.

If your pain is severe, your provider may prescribe stronger pain medicine.

In some cases, your provider may recommend physical therapy.

Outlook (Prognosis)

Costochondritis pain often goes away in a few days or weeks.

When to Contact a Medical Professional

Call 911 or the local emergency number, or go to your local emergency room right away if you have chest pain. The pain of costochondritis can be similar to the pain of a heart attack.

If you have already been diagnosed with costochondritis, contact your provider if you have any of the following symptoms:

• Trouble breathing
• A high fever
• Any signs of infection such as pus, redness, or swelling around your ribs
• Pain that continues or gets worse after taking pain medicine
• Sharp pain with every breath

Prevention

Because the cause is often unknown, there is no known way to prevent costochondritis.

Crasto JA, Vaswani RS, Pauyo T, Musahl V. Overview of sport-specific injuries. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Hanak JA. Tietze syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 117.

Kurz J. Costosternal syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 101.

Last reviewed on: 10/20/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Costochondritis | NHS inform

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

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

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

Tietze’s syndrome

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

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

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

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

Signs and symptoms

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

The pain may be made worse by:

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

When to seek medical help

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

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

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

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

Causes of costochondritis

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

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

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

Diagnosing costochondritis

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

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

These may include:

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

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

Treating costochondritis

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

Self-help

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

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

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

Painkillers

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

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

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

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

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

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

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

Corticosteroid injections

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

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

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

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

Transcutaneous electrical nerve stimulation (TENS)

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

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

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

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

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

Read more about transcutaneous electrical nerve stimulation (TENS).

Costochondritis – Medical center “Lіko-Med”

Publication date
October 3, 2018

Rubric
Diseases

What is costochondritis?

Costochondritis is an inflammation of the cartilage that connects the ribs and sternum. The inflammatory process causes pain in the chest on one or both sides. Certain diseases can lead to costochondritis, such as arthritis and fibromyalgia, trauma, and a viral or bacterial infection of the respiratory tract. However, the cause of the disease is usually unknown. Costochondritis is considered harmless. Very often it is mistaken for a heart attack. The disease is more common among women than among men. As a rule, the inflammation goes away on its own in a few days or weeks.

What to expect?

The pain of costochondritis can be severe, and the disease is often mistaken for a heart attack or lung disease. The inflammation usually goes away within a few days or weeks on its own. Pain relievers, ice packs, or heat can help relieve pain.

Distribution.

Costochondritis is diagnosed in 14% of adolescents and 30% of adults who complain of chest pain.

Risk factors .

– Belonging to the female sex.

– Over forty years of age.

Treatment.

Treatment of costochondritis includes:

– Applying heat or cold to the affected area.

– Use of anti-inflammatory drugs.

– Avoidance of activities that aggravate pain.

– Corticosteroid injections – for severe pain.

What can you do yourself?

Costochondritis is usually treated at home with anti-inflammatory drugs. It is useful to apply ice or heat to the area of ​​​​inflammation. If this does not help, see a doctor to assess the condition.

What makes it worse?

– Injuries.

– Twisting movements.

– With deep breaths.

– Sleeping on an uncomfortable bed with no pillow or mattress.

When to see a doctor?

See a doctor if:

– you wake up with pain;

– breathing problems;

– fever or signs of infection.

Chest pain that radiates to the left arm, along with sweating, nausea, or general chest pain that is not concentrated in one area, may be a sign of a heart attack and requires emergency care.

What to ask the doctor?

1. How often do I need to have a health check-up?

2. Do I need to have any tests or x-rays?

3. What symptoms should you seek medical attention for?

4. When will the condition improve?

5. What is the long-term prognosis of the disease?

Diagnosis.

Costochondritis is diagnosed based on the patient’s medical history and physical examination.

costochondritis: symptoms, causes, dangers and treatment

Introduction

Costochondritis is an inflammation of the costal cartilage that causes chest pain. In particular, the bone-sternal joints (where the ribs connect to the sternum) are susceptible to inflammation.

Also called osteosternal syndrome or costal chondritis, the main causes can be:

• chest trauma,
• excessive physical effort,
• infections,
• rheumatological diseases (ankylosing spondylitis, rheumatoid arthritis, …),
• certain cancers,
• fibromyalgia.

The most common symptoms of costochondritis are:

• chest pain, widespread or localized, aggravated by movement or pressure on the chest,
• pain radiating to the back or abdomen leading to pain in the back and abdomen,
• functional restriction of the chest in movements,
• constant feeling of tension.

If you experience chest pain, seek immediate medical attention to rule out the possibility of a heart attack; after ruling out heart problems or other serious pathologies (such as pulmonary embolism or pleurisy), using the history, physical examination, and some instrumental tests, the diagnosis of costochondritis can be made by exclusion.

Given that in most cases costochondritis resolves spontaneously within a few days, symptomatic treatment is based on rest and the use of anti-inflammatory and analgesic drugs.

The condition responds positively to physical therapy and some physical rehabilitation procedures (such as TENS and others).

Causes

This problem mainly affects women and adolescents, although anyone at any age can suffer from costochondritis; a large percentage of people suffer from costochondritis with no known cause (idiopathic), while known triggers include:

• Chest injury: any kind of injury to the ribs and sternum can be a precursor to costochondritis. The most common traumatic events are sports injuries (eg, football, rugby, American football, hockey, combat sports), physical assault, and car accidents.
• Excessive exercise: this refers to excessive sports activity in untrained subjects, lifting excessive weights, only in rare cases chronic and continuous cough.
• Infections: may be bacterial, viral or fungal, including:
  • syphilis,
  • tuberculosis,
  • aspergillosis,
  • candidiasis,
  • Staphylococcus aureus,
  • viral respiratory infections
• Rheumatological disorders, such as:
  • Ankylosing spondylitis,
  • Rheumatoid arthritis,
  • osteoarthritis
  • and various forms of arthritis (juvenile idiopathic arthritis, Reiter’s arthritis, psoriatic arthritis)
• Tumors: Several types of tumors can cause costochondritis, including:
  • lung cancer,
  • breast cancer,
  • bone metastases
• Fibromyalgia: A chronic disease of still unknown cause characterized by chronic muscle pain that is difficult to relieve, as well as stiffness and functional impotence. It often presents with pain at specific points, called trigger points, which are also present in the chest.

Symptoms

The main symptom of costochondritis is chest pain, which has several characteristics:

• It may be diffuse throughout the chest or localized to specific points at the level of the sternum or more laterally at the level of the ribs.
• Tends to be aggravated by chest movements (including coughing) or pressure on certain points.
• Tends to radiate to the back and abdomen, resulting in back and abdominal pain.
• May have a limited duration or remain fixed for some time.

May be associated with other symptoms such as

• constant feeling of muscle tension in the chest
• functional limitation of certain chest movements.

Diagnosis

If you experience chest pain, it is recommended that you seek immediate medical attention to rule out the possibility of a heart attack.

After ruling out more serious problems such as heart problems, the diagnosis can be made on the basis of

• history,
• physical examination,
• instrumental examination.

Anamnesis consists in the fact that the doctor formulates a series of questions in order to study and reconstruct the patient’s entire medical history. In this case, it is important to understand:

• when the pain occurred and what characteristics it has,
• if it may be due to injury or excessive exercise,
• whether it is aggravated by movement or pressure on certain trigger points.

At the end of this phase, the doctor is often already able to suspect possible costochondritis, but an objective examination allows to recognize all the symptoms reported by the patient and objective clinical signs, excluding, in particular, the presence of swelling at the level of the costal cartilage, characteristic of Tietze’s syndrome.

From an instrumental point of view, the following can be done:

These examinations are important to exclude

• heart or lung disease,
• rib fractures.

Costochondritis is not recognized on any instrumental examination, requiring a clinical (ie, symptom-based) diagnosis of exclusion.

Differential diagnosis

Costochondritis is included in the differential diagnosis with a number of other pathologies, the most important of which are:

• Rib fracture : in this case there is actual bone damage; in history – a serious injury to the chest, the pain is very intense and prolonged. In older people, due to osteoporosis, it can occur without noticeable chest trauma.
• Myocardial infarction : The pain is intense (less pronounced in diabetic neuropathy) and radiates to the shoulder and left arm. Before thinking about costochondritis, myocardial infarction must always be ruled out.
• Tietze’s Syndrome: This is a benign pain syndrome, manifested by chest pain localized in the region of the first 4-5 ribs. It is now recognized as a severe form of chronic costochondritis. A significant distinguishing factor from costochondritis is the presence of swelling and edema of the articular cartilage, which are absent in costochondritis, as well as the localization of pain:
  • Costochondritis usually affects the third, fourth and fifth costosternal joints,
  • Tietze’s syndrome usually affects the second or third costosternal joint.

In most cases, costochondritis resolves spontaneously within a few days.

Medical therapy is therefore symptomatic, i.e. associated with the elimination of symptoms, and is based on:

• absolute rest for several days,
• use of anti-inflammatory drugs (such as NSAIDs) and pain relievers (traditional such as paracetamol or opioid-derived for more severe pain),
• physical therapy and physical rehabilitation procedures such as TENS. The latter is a modern method used in pain therapy, which is especially effective in the treatment of chronic pain in the musculoskeletal system.