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.