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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What is chest myositis? How does it occur? What muscles are affected?

Myositis of the muscles of the chest is an inflammatory process in the muscles of the chest, in which there are painful indurations (they are foci of inflammation) and pain. The thorax is an anatomical formation that consists of the sternum, ribs, spine, and associated muscles. Myositis is an inflammatory process that, by definition, affects muscle tissue. Although, in some cases, it can spread to other places, for example, to the pleura – a film of connective tissue lining the chest from the inside.

What causes myositis of the pectoral muscles?

Various diseases can lead to the inflammatory process. Main causes:

• Infections, among which influenza and SARS are in the lead. In this case, myositis is considered as a complication of an infectious disease.
• Parasitoses. Parasites that live in the body can also cause chest myositis. But this rarely happens.
• Poisoning with certain substances. Another fairly rare reason.
• Features of the profession. Some people are forced to stay in positions for long periods of time that cause damage to the pectoral muscles and the development of inflammation in them. This category includes violinists, pianists, drivers.
• Muscle injuries. Common causes: mechanical trauma, frequent convulsions.
• Bacterial infection. Causes the most severe form of myositis, when a focus of purulent inflammation occurs in the muscle tissue. This is manifested by severe pain, fever, deterioration, malaise. The infection can spread to the pleura, lungs, and other organs. The disease can develop after injuries, non-compliance with aseptic and antiseptic rules during medical procedures.

When you are worried about chest pains, it is difficult to immediately understand what their cause is. Often, first of all, suspicion falls not on myositis of the pectoral muscles, but on problems with the heart, spine, intercostal neuralgia. An experienced doctor will be able to figure out why the symptoms occurred and prescribe the right treatment.

What are the forms of thoracic myositis?

Thoracic myositis may be acute or chronic. In the acute form of the disease, rather severe chest pains are disturbing. If not treated, over time, the course of the pathology becomes chronic. The pain becomes not so strong, and the person often ceases to notice it at all. An aggravation occurs during a cold, a long stay in an uncomfortable position, a change in weather.
Myositis of the chest can occur on the left or right, or on both sides. With left-sided localization, it can mimic heart disease.

There are also two specific chronic forms of the disease that affect different muscle groups: polymyositis and dermatomyositis.

Treatment of chest myositis

A neurologist prescribes the treatment of the disease individually for each patient.
First of all, you need to identify and eliminate the cause. If viruses are to blame, as a rule, specific antiviral treatment is not required. They carry out standard measures for a cold, after a while recovery occurs. Bacteria are fought with antibiotics, and parasites are fought with antiparasitics. In case of chronic trauma, rest is recommended, then the correct organization of work and rest.

General principles for the treatment of various forms of chest myositis :

• In the acute form of the disease, rest must be ensured. Damaged muscles must be kept warm, usually the chest is wrapped in woolen cloth.
• To relieve pain, painkillers from the group of non-steroidal anti-inflammatory drugs are used: such as diclofenac, ibuprofen.
• In some forms of myositis, finalgon and other warming ointments have a good effect.
• When the temperature rises, antipyretic drugs are used.
• Physiotherapy, massage, physiotherapy exercises are also used.

In the purulent form of the disease, it is often necessary to resort to surgical treatment: the abscess is opened and cleaned.

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The main manifestations of myositis of the chest muscles are pain in the affected muscles and painful indurations that correspond to foci of inflammation. The disease can occur in two forms:

• In acute myositis the symptoms come on quickly, suddenly, usually during an infection, after prolonged muscle tension, trauma.
• In the chronic form of , the manifestations increase gradually, it can be the result of untreated acute inflammation in the muscles.

Characteristic symptoms of chest myositis

The main symptom of chest myositis is pain. Its intensity gradually increases. Pain is aggravated during awkward movements, deep breaths, prolonged stay in a tense uncomfortable position. When feeling the chest in the area of ​​the affected muscles, pain is noted.

Sometimes swelling, swelling, redness of the skin can be found at the site of the lesion. This symptom is most characteristic of purulent myositis. At the same time, the patient feels weakness, malaise, his body temperature rises.

Protective muscle tension occurs – it helps to limit movement and reduce pain.

Pain in the muscles may disappear for several days, but then a relapse occurs, most often it is provoked by infections, hypothermia, trauma, stress.

Affected muscles become weak, in a chronic course they decrease in size over time – their atrophy develops.

How is chest myositis diagnosed?

Usually, the first thing a patient gets to see a therapist is because he does not know why he began to be disturbed by chest pains and other symptoms. Suspecting the neurological nature of the disease, the doctor refers the patient for a consultation with a neurologist.

A neurologist will ask you about your symptoms, when and how they started, how they have changed over time, what you have been sick with during your life, what chronic diseases you currently suffer from. A neurological examination will be performed. The doctor will press certain points on your chest to determine if there is any tenderness.

Further, to clarify the diagnosis and exclude other diseases, an examination will be prescribed, which may include the following diagnostic methods:

Magnetic resonance imaging, computed tomography, X-ray – help to detect foci of pathological changes in the muscles, bones, organs of the chest.

With what diseases is the differential diagnosis of signs of chest myositis carried out?
Similar chest pains and other symptoms described above can also occur with other diseases, such as:

• angina pectoris and other heart diseases;
• diseases of the lungs and pleura – a film of connective tissue that covers them;
• intercostal neuralgia;
• osteochondrosis of the thoracic spine.

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 they visit 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, we will divide them into four main groups: 2

Look at how many different specialists a person with complaints of chest pain should look at in order to identify its cause: a pulmonologist, a cardiologist, a neurologist and a 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 straighten out 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.