Costochondritis: what is it, symptoms and treatment

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Mr Shyamsunder Kolvekar –

Cardiothoracic surgery

What is costochondritis?

Costochondritis is a painful condition caused by the inflammation of the cartilage that joins the upper ribs with the rib cage. The condition causes chest pain, and while it is painful, it is relatively harmless and the pain often goes away on its own without treatment. 

Usually affecting adults aged 40 and over, costochondritis doesn’t cause permament damage, but it can sometimes relapse.  

What are the symptoms?

The main symptoms are sharp chest pain (usually between the fourth, fifth and sixth rib) and tenderness, although it can also affect the abdomen or the back.

The pain, which is very often caused by the numbness, is diffused and mainly affects the left side of the chest. It can worsen with upper body movements, coughing, physical activity or deep breathing. 

What are the causes?

There usually isn’t a cause for costochondritis but the condition has sometimes been linked to:

• chest injury: usually provoked by an impact while practicing sports (rugby, football…)
• arthritis: rheumatoid arthritis and psoriatic arthritis, spondylitis
• bacterial infections: tuberculosis, syphilis, candida, salmonella, aspergillosis and other infections affecting the respiratory system
• physical activity: persistent cough, lifting heavy objects
• tumours: breast, thyroid or lung cancer
• fibromyalgia: pain and increased muscular stiffness affecting the musculoskeletal system.

Fibromyalgia can be a cause of costochondritis

How is costochondritis diagnosed?

If you have symptoms of costochondritis, your doctor will examine your upper chest area (around the costochondral joint) and ask you where the pain occurs. Your doctor might also want to take a look at your medical history. 

Some tests may need to be carried out before a costochondritis diagnosis can be confirmed, such as: 

• ECG (electrocardiogram) to record the electrical activity of your heart
• blood test to check for inflammation
• X-ray of the chest

What is the treatment?

Costochondritis can be treated with: non-steroidal anti-inflammatory drugs, rest, alternation of hot and cold packs over the affected area, and physiotherapy. Treatment will focus on relieving pain. 

Avoid any type of activity that places stress on your chest area, including physical exercise and simple chest movements, until the inflammation is better. 

Which specialist should you visit?

Don’t ignore long-term chest pain. Pay a visit to your GP, who can find out the cause and refer you for specialist treatment if necessary. 

Chest pain due to costochondritis might be mistaken with chest pain caused by more serious conditions, like a heart attack. Call an ambulance if you experience sudden chest pain and believe it could be a heart attack. 

Costochondritis and pregnancy

Due to the expansion of the rib cage during pregnancy (mostly in the last trimester), some pregnant women may experience costochondritis in the upper and lower ribs.  

If you’re pregnant, your doctor might advise hot and cold packs or gentle stretching to help alleviate chest pain and painful breathing. 

Why is costochondritis worse at night? 

Costochondritis might feel worse when you lay down to sleep because your body weight causes further straining onto the already stretched rib joints around your back. Sleeping in an elevated position can help to reduce the degree of pain. 

How long can costochondritis last for?

Costochondritis will usually heal on its own in one to three weeks‘ time, although in some cases, it can last from a few weeks to several months. Almost all cases of costochondritis will be resolved within a year.

What if costochondritis returns? 

A relapse occurs when costochondritis returns after it heals. In this case, you will need to seek long-term medical care and advice to reduce the impact of costochondritis on your quality of life. 

Straining the affected areas can cause your pain to return. That is why rest is an essential part of the recovery process for costochondritis. 

How You Sleep Determines Your Health. How I cured my costochondritis… Update 4 years later. | by Faye

5 min read

·

Jan 23, 2021

4 years ago, I was diagnosed with Costochondritis. Costochondritis is a condition that causes chest pain due to inflammation of the cartilage and bones in the ribcage. Pain that could mimic a heart attacks or heart conditions. At 21 I thought I was having a heart attack, shooting sharp pains in my right rib cage that had me uncontrollably screaming in pain. After 2 hospital visits (one was an ER vist), I was diagnosed with costochondritis. I asked the doctor how I got it, I was told “it happens”. I was disappointed with that answer which led me to do countless research in search for the cause, all leaving me with the same answer that Costochondritis has no clear cause. I was in pain. My right ribcage was inflamed, I could barely walk because I was in excruciating pain, and even breathing hurt! I was frustrated and I knew that googling and searching online for an external source was not going to cure me internally and that it was up to me to figure out what was going on with my body. I took the time and listened to my body. I reflected how I’ve been living the 2 weeks prior to my diagnosis. I inspected every pain episode, I thought about the physical activities I did, how I slept, how I ate, etc. I was dedicated in solving it as if it was my life was at stake. And I figured it out….

2 weeks after I was diagnosed with Costo, I figured it out what caused it and started recovery that eventually lead me to fully recover.

It’s been 4 years since I was diagnosed and haven’t felt that pain since. Costo was something I never really talked about and often forget I had because I recovered. Its all in the past for me. I published an article on medium 4 years ago about my story, my experience and had over 12k views. I have people emailing me to this day asking for advice. I joined this Facebook group Costochondritis Support Group with thousands of people suffering from costo and are desperate for a solution. And me being one of the few rare ones that fully recovered, I decided I wanted to share my experience and my perspective in hopes that people will recover.

https://medium.com/@fayetagle/i-was-diagnosed-with-costochondritis-6d51d62afa8

Your sleeping position has a profound impact on your health on so many levels. I realized that what caused my Costochondritis was how I was sleeping. I was sleeping on my side.

There are many factors that led me to costo, however, the main factor and the most significant that factored to my costochondritis was that I was sleeping on my right side. Months leading up, I was sleeping on my right side and I woke up on my right side. 8–9 hours every day sleeping in an improper position created unnecessary tension and pressure on my right side. (Imagine me in college days, living in a dorm with noisy roommates, stressed with assignments, my bed against the wall, sleeping on my right side facing the wall, unconsciously trying to get away and feel more comfortable… we tend to face our body’s to the wall unconsciously when we sleep to feel more at ease.) My costo pain was on my right side and I was sleeping on my right side.

Whichever position you sleep is where you direct the flow of blood simply because of gravity. If you sleep on your right or left side is where you direct the flow of blood. Its simple physics. This will inevitably put unnecessary tension and pressure in certain areas of your body because there is no balance in the flow of blood throughout simply because of improper position. Sleeping in an improper position creates poor blood circulation throughout, causing imbalance and poor recovery.

Lets say your fulltime job is lifting boxes. If your lifting the boxes with improper form, you will eventually injure your back simply because improper form is putting unnecessary pressure on a specific area on your body. If you lift any weight with correct form, the distribution of the weight’s pressure in your body will even out. This is the reason so many package delivery workers have back problems simply because they’re lifting boxes every day for 8–10 hours, 5 days in a week with improper form. This is what happens when you sleep an improper position. If you’re constantly putting pressure on your body 7–9 hours a day, every day, for the rest of your life eventually some pain or injury will happen.

When sleeping on your back, your spine is align in a neutral position, allowing the blood to flow throughout the body having no tension or pressure. Your body is at its most relaxed state and your organs functions at its best when you sleep on your back. We sleep to recover. You need proper form that would allow for your body to restore itself.

I know, I thought the same too when I first started…. however I trained myself. I knew that the pain I felt, the sudden, sharp, stabbing pain, I never wanted to feel that again..

and I didn’t.

It may seem uncomfortable to make the changes but you have to take care of your body now. You shouldn’t suffer and hope one day it miraculously goes away. It won’t. You have to take responsibility in your health and take the necessary steps to improve your health. Its a process, it will take time to fully recover. Costochondritis may be difficult to manage, however, I will leave you with this quote that speaks the practicality and reality of every day life,

“But difficult does not mean impossible, difficult means a little more effort. Difficult means a little more determination. Difficult means a little more intention.” -Osho

1. Your mattress, should be firm, a mattress that is too soft will cause your spine to fall out of alignment. We spend almost a third of our lives in bed, so get rid of your old mattress and invest in a mattress that would support your spine and overall improve your health.
2. Your pillow should be ergonomically designed for back sleeping. Every pillow is designed differently. Having the right pillow plays an important role in keeping your body align.
3. Listen to your body, Your body is sending you messages whether you‘re aware of it or not. Be attentive to the messages your body is trying to communicate with you. For example I was constantly feeling stiffness in my neck, that had me always cracking my neck to relieve tension. I realized it was the pillow I was using and bought a new pillow and hadn’t had tension in my neck since. How does your body demand attention?

Take care.

How to Treat Costochondritis: 15 Steps (with Pictures)

Costochondritis, also called chest wall pain, costo-thoracic syndrome, or costo-sternal chondrodynia, occurs when the cartilage between the rib and the sternum (breastbone) becomes inflamed and swollen. Symptoms can mimic a heart attack, so always see a doctor at the first sign of chest pain to rule out a heart attack. Your doctor will also be able to advise you on the best way to manage the pain while you wait for it to go away.

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Steps

Part One of 3: Seeking Medical Care

1. one Call your doctor or emergency services immediately if you experience chest pain. The health care provider will be able to determine if this is a heart attack or something less serious, such as costochondritis.

   • Know what to expect at the doctor’s office. Your doctor will likely palpate (look with your fingers) at your sternum to determine where it hurts and how much it is inflamed. If it can reproduce pain on palpation, it is most likely costochondritis and not a heart attack. She will also likely ask about events in your life, such as recent traumas, that could be the cause.
   • Your doctor may ask you to have other tests to rule out other conditions often associated with chest pain, including osteoarthritis, lung disease, gastrointestinal disease, or joint infection. She may request an x-ray, CT scan, MRI, or electrocardiograph.
   • Tell your doctor if you have had heart, liver, or kidney disease, high blood pressure, ulcers, or internal bleeding in the past. This knowledge will help your doctor tailor your pain management plan to what works for you.

2. 2 Take prescription antibiotics if your doctor tells you to. If your case of costochondritis is caused by a joint infection, your doctor will likely prescribe oral or drip antibiotics.

   • This is not usually necessary as infections rarely cause ribochondritis.

3. 3 Discuss prescription drug options with your doctor. If your pain doesn’t go away after a few weeks and over-the-counter non-steroidal anti-inflammatory drugs don’t help, your doctor may suggest something stronger to help you manage your pain. Possible prescription drugs may include:

   • Prescription non-steroidal anti-inflammatory drugs (NSAIDs) similar to ibuprofen (Advil, Motrin). This is the main treatment for costochondritis. If you are taking them for a long period of time, you should be under medical supervision because they can harm your stomach and kidneys.
   • Medicines containing codeine such as Vicodin, Percocet, etc. These medicines can be addictive.
   • Some antidepressants or anticonvulsants may also be effective in treating chronic pain.

4. 4 Consider more invasive procedures to manage pain. Most cases of costochondritis go away on their own with time. But if the pain remains unbearable, the doctor may advise:

   • Injection of corticosteroids and painkillers directly into the painful joint.
   • Transcutaneous electrical nerve stimulation (TENS). This method uses weak electrical signals to interrupt pain signals and prevent them from registering in your brain.

5. 5 Discuss surgical options for removing or repairing damaged cartilage if nothing else works. Sometimes this is necessary, especially if the cartilage is severely damaged by infection.

   • In combination with antibiotics, the result is usually very good.
   • After recovery, have annual checkups to make sure the joint stays healthy.

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Part 2 of 3: Managing Pain at Home

1. one Try over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs are most effective. Ask your doctor if he recommends using over-the-counter pain relievers. These medicines may give you some relief.

   • If you are taking prescription medication for this or any other condition, check with your doctor before taking any over-the-counter medication. Your doctor will be able to tell you about any possible interactions between over-the-counter medicines and your other medicines.
   • Follow the manufacturer’s instructions and consult your doctor if you plan to use them for more than a few days. Do not take more than indicated in the instructions.
   • Talk to your doctor before using these medicines, even over-the-counter ones, if you have heart disease, high blood pressure, kidney disease, liver disease, or are prone to stomach ulcers or internal bleeding.

2. 2 Rest to give your body time to recover. This may mean that you will have to refrain from heavy sports for several weeks. Costochondritis usually results from activities that stretch the cartilage and muscles around the chest wall. The number one treatment prescribed by a doctor is avoidance or rest from activities that cause discomfort. The pain usually goes away after a few days or weeks, but it can take up to several months.

   • Rest until pain is gone.
   • Slowly bring physical activity back into your life to give yourself time to build on lost muscle and endurance.
   • Be especially careful with activities that require sudden movements, high stress on the pectoral muscles, or risk of being punched in the chest. These include tennis, baseball, golf, basketball and karate.

3. 3 Apply heat to the affected area. It can help increase blood flow and relax muscles that may be tight.

   • Use a heating pad or heating blanket.
   • Do not apply a heat source directly to the skin. If you are using a heating pad, wrap it in a towel so you don’t burn yourself.
   • Apply heat for a few minutes and then remove it to allow the skin to cool.

4. 4 Place an ice pack on the affected joint. A joint is a painful area where the sternum and ribs meet. The ice will help reduce swelling and reduce inflammation.

   • A bag of frozen peas or corn wrapped in a towel makes ice quickly and conveniently.
   • Do not apply ice pack directly to skin.
   • Remove the ice pack after 15-20 minutes and allow the skin to warm up. Repeat this three to four times a day.

5. 5 Stretch tight chest muscles around the joint. But be careful, do it slowly, carefully and only with the approval of a doctor. Your doctor may refer you to a specialist to find out which exercises are best for your injury.

   • Start by inhaling slowly and lightly, stretching your chest muscles.
   • When ready, add a pectoral stretch. An easy way to do this is to place your forearm against a doorway and then slowly lean forward until you feel a stretch in the muscles below and around your shoulders.
   • Yoga poses combined with deep breathing are a great way to relax and stretch. Try Sphinx Pose. Lie on your stomach, leaning on your elbows. Then open your chest by stretching up and back.
   • If exercise causes pain, stop immediately to avoid injury.

6. 6 Experiment with different sleeping positions until you find one that minimizes discomfort. Try to avoid positions that put pressure on the painful joint.

   • Sleeping on your stomach may be uncomfortable.

7. 7 Improve your posture to reduce pressure on your chest. A hunched sitting or standing position can aggravate your costochondrosis and increase your discomfort.

   • Practice sitting, standing and walking with a book balanced on your head.
   • Concentrate on opening your chest and relaxing your shoulders.

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Part 3 of 3: Understanding Symptoms and Causes

1. one Recognize the symptoms. Costochondritis can cause severe discomfort. Patients describe the pain as:

   • Sharp, aching or pressure-like pain located on the side of the sternum. The usual places are the fourth, fifth and sixth ribs.
   • Pain may also radiate to the abdomen or back.
   • Pain may involve more than one costal joint and may be aggravated by coughing or deep breathing.

2. 2 Be aware that because the main symptom is chest pain, it can be difficult to distinguish costochondritis from the onset of a heart attack. The key difference is that in costochondritis, the painful area is usually sensitive to touch, and the pain is reproduced when the doctor examines you and flutters in that area. However, in all cases of chest pain, it is best to see a doctor right away to rule out a heart attack.

   • As at the beginning of a heart attack, the pain is often on the left side. It can be sharp and worse when you take a deep breath, turn your body, or move your arm.
   • A heart attack is usually a dull pain associated with numbness in the arm and jaw.

3. 3 Know what can cause costochondritis. Costochondritis occurs for various reasons. Here are some common ones:

   • Injury that damages the cartilage connecting the rib and sternum. This could be a blow or strain while carrying heavy objects, or a severe cough. An upper respiratory infection that causes a severe cough can cause costochondritis.
   • Arthritis of the joint. Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis can cause chest pain.
   • Infection of the joint, such as tuberculosis, syphilis or aspergillosis. Sometimes the cause of costochondritis is a bacterial infection of the joint after surgery.
   • Tumor affecting the joint.
   • In other cases, the cause may not be clear.

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Community Q&A

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• Matsko has been honored with the Pittsburgh Cornell University Excellence in Leadership Award. He holds a Bachelor of Science in Nutrition from Cornell University and a PhD from Temple University School of Medicine in 2007. Dr. Matsko received a Research Paper Certificate from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing and Editing Certificate from the University of Chicago in 2017. Chris M. Matsko, MD Family Medicine Physician Expert’s answer: Yes, there is manipulation of the chest during cardiac surgery, so I can foresee that costochondritis may develop later after surgery.
• Q: How does smoking affect costochondritis? Chris M. Matsko, MD
  Family Medicine Physician Dr. Chris M. Matsko is a retired physician from Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko has been honored with the Pittsburgh Cornell University Excellence in Leadership Award. He holds a Bachelor of Science in Nutrition from Cornell University and a PhD from Temple University School of Medicine in 2007. Dr. Matsko received a Research Paper Certificate from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing and Editing Certificate from the University of Chicago in 2017. Chris M. Matsko, MD Family Medicine Physician Expert Answer There is no link between smoking and costochondritis. Costochondritis is a musculoskeletal disorder and a problem with the chest or sternum.
• Question. Can pain with ribochondritis move from the chest to the arm? Justin Bush Yes, but it will be in the chest and in the arm. The pain may radiate to the arms, neck, and back.
• Question: Is it possible to walk with costochondritis? Walk normally. Rest is best because it reduces inflammation, but you can still walk. If walking causes you severe pain, then you should limit walking to simply moving around the house.
• Question: If I have been diagnosed with costochondritis, how long do I have to wait before I can continue with weightlifting? It depends on the; recovery is different for everyone. However, you should wait until your pain is completely gone before resuming weight lifting.
• Q: Does caffeine affect costochondritis? Justin Bush This can lead to worsening of symptoms. Along with that, it can also increase your anxiety, and increased anxiety can make symptoms worse. Some cases of costochondritis are caused by stress.
• Question: How long does it take to recover from costochondritis? It depends on the severity. Mild attacks resolve within a few days or weeks; chronic cases can last up to a year or more (although this period is rare).
• Question. Does lifting heavy weights cause costochondritis? Maybe if, when lifting weights, the wrong posture and body shape.
• Question Can a heating pad be used for costochondritis? Yes. Heat increases blood flow and relaxes tense muscles around the affected area.
• Q: Does smoking affect costochondritis? Yes.

Show more answers Unanswered questions

• Can amoxicillin help with costochondritis? Answer
• Will my breasts be painful and swollen with costochronitis? Answer
• How do I know if I have costochondritis or an infection? Answer
• Can a chest injury cause costochondritis? If yes, can it compress the nerve? Answer
• Topical CBD cream or magnesium oil spray reduce inflammation caused by costochondritis? Reply

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How long does costochondritis last? – Medicines and vitamins

Medicines and vitamins

• Medical Reviewer: Poonam Sachdev, MD

• What’s happened
  • What is costochondritis?
• What does costochondritis look like?
  • What does costochondritis look like?
• How long does the pain last
  • How long does costochondritis pain last?
• Diagnosis
  • How is costochondritis diagnosed?
• Care
  • How is costochondritis treated?
• When to See a Doctor
  • When should I see a doctor?

What is costochondritis?

Costochondritis is an inflammation of the chest wall between the sternum and ribs. Costochondritis usually resolves on its own, although inflammation can last from weeks to months.

Chest pain can be scary. If your chest hurts, the first guess might be that you’re having a heart attack.

There are soft tissues in the breast that can be irritated due to infection, injury or an autoimmune disease. One cause of inflammation from this irritation is costochondritis. pain this may seem like a heart attack, but the cause is unrelated.

Costochondritis is an inflammation of the chest wall between the sternum and ribs. Most of the ribs and sternum are connected by cartilage. This cartilage can become inflamed and cause chest pain. There is no single definite cause of costochondritis, but it is often caused by trauma, overuse, sports injuries, or arthritis.

Costochondritis is also known as costo-sternal syndrome, parasternal chondrodynia and previous chest syndrome.

What does costochondritis look like?

The main symptom of costochondritis is pain. However, other symptoms do exist. They include:

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• Left chest pain
• Sharp or dull pressure
• Multiple ribs affected
• Pain with deep breathing or cough
• Pain in the chest which may radiate to the back or stomach
• Gentle pressure pain rib/thoracic region
• Stopping pain when you sit still

Costochondritis is more common in women and people over forty years of age. If there is associated swelling, the condition is known as Tietze’s syndrome, and it affects young adults.

How long does costochondritis pain last?

Costochondritis is a self-limiting, benign condition. It is not related to the heart and other causes of pain must be ruled out because this is usually a diagnosis of exclusion.

Costochondritis usually resolves on its own, although it sometimes lasts longer. The inflammation can last from weeks to months and can limit your ability to work and participate in daily activities without pain. Pain usually worsens with deep breathing and movement of the upper body. longevity Symptoms vary depending on whether the condition was caused by a recent upper respiratory illness or recent exercise.

How is costochondritis diagnosed?

Costochondritis is diagnosed by a doctor. They will do history and physical examination. The examination will involve applying pressure to the area where the sternum and ribs meet. The diagnosis of costochondritis is usually made if the area is sore and painful.

A chest x-ray may be done if symptoms are severe or if symptoms do not improve with treatment. They may also run tests to make sure you haven’t had a recent heart attack.

The pain experienced may resemble that of lung disease, gastrointestinal problems, and arthritis. The differential diagnosis (i.e. other similar diseases) includes:

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• herpes zoster of the chest
• myalgia
• traumatic muscle pain
• sliding rib syndrome
• fibromyalgia
• painful xiphoid syndrome

How is costochondritis treated?

In many cases, costochondritis can go away on its own. If not, there are several treatment approaches depending on the symptoms. Treatment is aimed at relieving pain. The simplest treatment approaches include:

• Cold or hot compresses
• Cessation of strenuous activity
• OTC pain relievers such as Advil, Tylenol, and Alev

In some cases, if the pain is severe enough, the doctor may prescribe strong pain medication. Sometimes, physical therapy may be needed. Therapy that usually helps with symptoms includes stretching exercises and nerve stimulation. With transcutaneous electrical nerve stimulation, a weak electrical current is used to hit the area of ​​pain – hopefully masking the pain signals so they don’t reach your brain.

If none of these work, the last step may be to inject drugs and steroids directly into the area of ​​pain.

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Atypical treatment includes antidepressants. They are known to treat chronic pain that makes it difficult to sleep at night. Anti-seizure drugs are also well established in the treatment of chronic pain.

When should I see a doctor?

Sometimes costochondritis goes away on its own. Because it is a medical problem with chest pain, it should be carefully monitored. You should call your doctor or call 911 if you have severe chest pain. It never hurts to be persistent in figuring out what’s wrong!

Also, whether you have already been diagnosed or not, you should call your doctor if you have:

• Fever
• Signs of infection such as swelling, redness, or being placed near your ribs
• Pain that gets worse even with medication
• Severe pain with every breath

In general, costochondritis is a musculoskeletal disorder that mimics other conditions that cause chest pain. If you have chest pain, you should see a doctor as soon as possible. Identifying the cause of your pain early can help prevent future complications.

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referenced literature SOURCES:

Cureus: “Atypical costochondritis: complete resolution of symptoms after rib manipulation and soft tissue mobilization.