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 — Symptoms, Causes, Tests, and Treatment for Costochondritis — from WebMD

Written by WebMD Editorial Contributors

• What Is Costochondritis?
• Costochondritis Causes
• Costochondritis Symptoms
• Costochondritis Risk Factors
• Costochondritis Diagnosis
• Costochondritis Treatment and Home Remedies
• Costochondritis Prevention
• Costochondritis Outlook
• More

Costochondritis is inflammation of the areas where your upper ribs join with the cartilage that holds them to your breastbone. These areas are called costochondral junctions. The condition causes chest pain, but it’s typically harmless and usually goes away without any treatment. But any chest pain in adults should be taken seriously, so you should be examined and tested for heart disease.

A rare condition called Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by the following:

• Tietze syndrome usually comes on all of a sudden, with chest pain spreading to your arms or shoulder and lasting several weeks.

• Tietze syndrome causes swelling at the painful area (where your ribs and breastbone meet).​​​​​​​

Doctors don’t know exactly why costochondritis happens, but they do know that some things can lead to it: 

• Repeated minor trauma to your chest wall
• Overuse of your arms
• Arthritis. Costochondritis can sometimes be a sign of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other conditions that affect your cartilage.
• Tumors. These can move from joints and other parts of your body and settle in your chest.
• Respiratory infections caused by viruses 
• Bacterial infections, especially in people who use IV drugs or have had surgery near their upper chest 
• Fungal infections (in rare cases)

Chest pain linked to costochondritis usually comes on after exercise, minor trauma, or an upper respiratory infection.

• Sharp pain in the front of  your chest, near where your breastbone and ribs meet, typically on the left side. It may spread to your back or belly.
• Pain when you take a deep breath or cough. It gets better when you stop moving or your breathing is quieter.
• Tenderness when you press on your rib joints. If you don’t have this tenderness, you probably don’t have costochondritis.
•  If costochondritis happens because of an infection after surgery, you’ll have redness, swelling, or pus discharge at the site of the surgery.

Call your doctor if you have any of the following:

• Trouble breathing
• High fever
• Signs of infection such as redness, pus, and increased swelling at the rib joints
• Continuing or worsening pain despite medication
• Nausea
• Sweating
• Dizziness

Go to a hospital’s emergency room if you have a hard time breathing or any of the following. They’re not usually caused by costochondritis:

• High fever that doesn’t get better with fever reducers such as acetaminophen or ibuprofen
• Signs of infection at the tender spot, such as pus, redness, increased pain, and swelling
• Persistent chest pain of any type when you also have nausea, sweating, or pain in your left arm. These may be signs of a heart attack. If you’re not sure what’s causing your chest pain, go to the emergency room.

Costochondritis is a common cause of chest pain in children and adolescents. It accounts for 10% to 30% of all chest pain in children. Annually, doctors see about 650,000 cases of chest pain in people ages 10 to 21. The peak age for the condition is ages 12-14.

Kids who often carry heavy book bags over one shoulder can be more likely to develop costochondritis.

In adults, costochondritis affects women more than men (70% vs. 30%).  

There is no specific test for diagnosing costochondritis. To rule out a more serious cause of your chest pain related to your heart or lungs, your doctor will probably start with tests like an echocardiogram (ECG), chest X-rays, and blood test for heart damage, among others. 

If those tests come back normal, they’ll likely see if you have tenderness in any of your rib joints, usually over the fourth to sixth ribs.

If you’ve had sternum (breastbone) surgery or are at risk for heart disease, they may recommend getting a test to see if infection is the cause of your chest pain. Doctors will:

• Look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery
• Recommend a more sophisticated imaging study of the chest called a gallium scan, which will show an increase in the radioactive material gallium 
• Check your white blood cell count to see if it is high, a sign of infection
• Recommend a chest X-ray if pneumonia might be a cause of your chest pain

Home Remedies for Costochondritis

These home remedies may provide relief from costochondritis:

• Over-the-counter  pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen as needed
• Using local heat or ice to relieve pain
• Avoiding unnecessary exercise or activities that make the symptoms worse; avoiding contact sports until there is improvement in symptoms, and then returning to normal activities only as tolerated
• Doing stretching exercises

Medications for Costochondritis

Your doctor may suggest the following:

• Prescription-strength NSAIDs.
• A local anesthetic and steroid injection in the area that is tender if normal activities become very painful and the pain doesn’t get better with medicine.
• Narcotics like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) can help with extreme pain, but, as with any narcotics, there’s danger of becoming addicted to them.
• Steroids. Your doctor can give you a corticosteroid shot directly into a painful joint, but that’s considered something of a last resort.
• Tricyclic antidepressants or cyclic antidepressants like amitriptyline can help ease pain, but they also can have side effects, like weight gain and drowsiness. 
• Antiseizure drugs, usually gabapentin (Neurontin), are typically used to treat epilepsy, but they also may help with costochondritis.
• Infectious (bacterial or fungal) costochondritis should be treated with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another 2 to 3 weeks. You should see a doctor during recovery, and then once a year. 

Surgery for Costochondritis

You may need surgery to remove the sore cartilage if other treatments don’t help. Your doctor can refer you to a surgeon.

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. Most people will recover fully.

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

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Lactational mastitis

The most common type of breast infection is lactational mastitis. With this condition, which occurs when a woman is breastfeeding, women’s nipples become cracked and sore, allowing bacteria from the baby’s mouth to enter the ducts and multiply rapidly in the milk. Sometimes the infection comes from a blocked milk duct. In both cases, the chest becomes hard, reddened, hot and sore.

The doctor may also prescribe antibiotics and painkillers. In some cases, lactational mastitis progresses and forms an abscess, a more serious condition that may require drainage.

Non-lactational mastitis

Non-lactational mastitis is similar to lactational mastitis but occurs in non-breastfeeding women. In some cases, this condition occurs after a lumpetomy followed by radiation therapy in women with diabetes or in those who have reduced immune functions in the body.

Although rare, this condition is usually accompanied by high fever and headache and is treated with antibiotics. Consult your doctor for diagnosis and treatment.

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Mastalgia (chest pain)

Classified as cyclic pain (associated with menstrual periods) or non-cyclic. The latter may come from the chest or may come from somewhere else, such as near the muscles or joints, felt in the chest. In some cases, pain can range from minor discomfort to severe. Many women with mastalgia worry more about the fear of cancer than the pain itself.

Cyclic chest pain

The most common type of chest pain is associated with the menstrual cycle and is almost always hormonal. Some women begin to experience pain during ovulation, which continues until the start of the menstrual cycle. The pain may be subtle or so severe that the woman cannot wear tight clothing or endure close contact of any kind. The pain may be felt in only one breast or in the area under the arm.

Doctors continue to study the role of hormones in cyclic mastalgia. One study showed that some women with cyclic mastalgia experienced a decrease in the ratio of progesterone to estrogen in the second half of their menstrual cycle. Other studies have shown that an abnormality in the hormone prolactin can affect breast pain. Hormones can also influence cyclical stress-related chest pain – sensations can increase or change in texture with hormone changes that occur during times of stress.

Hormones cannot give a general response to cyclic breast pain because the pain is often more severe in one breast than the other (steroids tend to affect both breasts equally).

Treatment includes:

• avoiding caffeine
• vitamin E
• low fat diet
• In some cases, various additional hormones and hormone blockers are also prescribed. These may include:
  • birth control pills
  • Bromocriptine (which blocks prolactin in the hypothalamus)
  • Danazol, a male hormone
  • thyroid hormones
  • Tamoxifen, an estrogen blocker

Noncyclic chest pain 9 0027

Non-cyclic chest pain rather unusual, distinct from cyclic mastalgia and does not change during the menstrual cycle. As a rule, the pain is present all the time and is located only in one specific place.

One of the causes of non-cyclic chest pain is trauma or impact. Other causes may include arthritic pain in the chest cavity and in the area of ​​the neck that reaches the chest.

Doctors usually do a physical examination and a mammogram. In some cases, a biopsy is also needed. If the pain is determined to be caused by a cyst, it will be aspirated. Depending on where the pain occurs, treatment may include analgesics, anti-inflammatory drugs, and compresses.

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Chest pain | LRC. Treatment and Rehabilitation Center of the Ministry of Economic Development of Russia

Chest pain is one of the most common complaints made by patients when visiting a doctor. There are many reasons leading to this problem. We will only talk about the most common of them.

Causes

To make it easier to understand the causes of chest pain, let’s break them down into four main groups:

• Diseases of the respiratory system
• Musculoskeletal diseases
• Diseases of the heart and great vessels
• Diseases of the digestive system

See how many different specialists a person with complaints of chest pain should see to identify its cause: pulmonologist , cardiologist, neurologist and gastroenterologist. Therefore, it would seem to me more reasonable and correct, when this complaint appears, to first turn to a competent therapist, so that he can figure out which organ system is the cause of the pain, and then advise which specialist to contact.

Since I am a pulmonologist, I will try to answer the question:

When do chest pains occur in bronchopulmonary diseases?

Why the lungs “do not hurt”

There are no pain receptors in the lung tissue, so pain in diseases of the bronchopulmonary system occurs only if the sheets covering the lungs – the pleura – are affected. No wonder the pain in these diseases is called “pleural pain.”

Another cause of chest pain in bronchopulmonary diseases can be tracheobronchitis.

Mechanism of “pleural pains”

In a healthy state, during breathing, two layers of the pleura (one covers the lung, the other lines the chest wall from the inside) slide over each other’s surfaces, which allows the lungs to collapse and expand freely and painlessly during breathing. When these sheets become inflamed or growths appear on them, during breathing, they rub against each other due to the resulting “irregularities” (roughness). As a result, pain with deep breathing and coughing.

Causes of “pleural pain”

• The first and most common cause of “pleural pain” is inflammation of the pleura itself and/or the lung covered by it. No wonder some types of pneumonia are called pleuropneumonia, that is, inflammation of the lungs and pleura.
• Tumor diseases of the pleura and lungs can also become the cause of “pleural pain”.
• Pneumothorax (air entering the pleural space) can also cause pain.

Features of “pleural pain”

“Pleural pain” is most often unilateral, acute, aggravated by deep inspiration and coughing. The pain is sometimes so severe that it forces the person to take only shallow breaths.

The person takes the so-called “forced position”, that is, he tries not to breathe on the side of the chest where the source of pain is located. To do this, he lies down on the affected side or presses it with his hands, thus limiting the mobility of the chest.

Please note that in some cases, when fluid begins to accumulate between the layers of the pleura, pushing its layers apart and not allowing them to “rub” against each other, the pain in the chest decreases, but shortness of breath appears.

What to do?

First of all, consult a doctor. The doctor can hear the rubbing noise of the pleura, make an x-ray of the chest, ultrasound of the pleural cavity, CT of the chest to assess the damage to the lungs and pleura.