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Inflammation in the chest area: Costochondritis | NHS inform

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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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Myositis of the chest

Myositis of the chest is a pathology of the pectoral muscles, in which pain and tender lumps occur in the chest area. If the disease is not treated in a timely manner, it can give complications in the form of atrophy of muscle tissue, as well as disruption of the organs located in the chest. In some cases, chest myositis occurs without symptoms at all, but most patients still complain of limited mobility at the site of inflammation and pain. Myositis of the chest is a really serious disease that requires immediate treatment.

In our work, we focus on the general improvement of the patient’s body and the launch of self-healing processes. The attending physician provides deep contact with the patient, tracking his changes. Our approach does not involve taking pills and performing operations.

With any procedure, the patient receives not only treatment, but also attention: the doctor helps to cope with nervous tension and gives recommendations for self-help in the future.

The practices we use help to relax muscles that have been in hypertonicity for a long time, to restore joint mobility.

The methods of Tibetan medicine involve a longer, but at the same time the most gentle treatment, the principles of which are not aimed at eliminating the symptoms, but at working with the causes of the disease.

Why does myositis of the pectoral muscles occur?

Inflammatory process in the area of ​​the pectoral muscles can occur due to various diseases and external factors that affect the general health of a person. The reasons for the appearance of myositis, experts of traditional (Western) medicine include:

  • Infectious diseases. For example, influenza or SARS. Myositis can be the result of transferred viruses.
  • Physical activity. Some people suffer from myositis due to improperly structured workouts in the gym, while others daily lift weights at work, which leads to the onset of this disease.
  • Parasites. Parasitic myositis occurs rarely even if parasites live in the human body, which cause the disease.
  • Muscle injuries and bruises. It can be mechanical injuries or regular convulsions.
  • Bacteria can cause one of the most severe forms of myositis. In such cases, a purulent focus appears in the muscle tissue. This is accompanied by a deterioration in the general condition, severe pain, fever, weakness. The infection can also spread to other organs. For example, on the lungs.

Non-traditional (oriental) medicine considers disease as a manifestation of an imbalance in the three channels of the human body. Weakened immunity and diseases of the musculoskeletal system are the results of the disharmony of “Slime” and “Wind”. Thus, Eastern wisdom in interpreting the causes of myositis of the pectoral muscles complements the theory of traditional medicine.

What are the forms of thoracic myositis?

Today, there are two forms of myositis of the pectoral muscles – acute and chronic. The first is usually accompanied by severe pain in the chest area.

In the absence of proper treatment, the acute form flows into the chronic, then the pain dulls. The patient gets used to unpleasant sensations and does not pay attention to them. But at the same time, exacerbations steadily occur against the background of colds, changes in weather, or a long stay in an uncomfortable position.

Myositis can occur on the left side of the chest or on the right. In the first case, it can be confused with heart disease.

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Characteristic symptoms of chest myositis

The following symptoms of intercostal myositis are distinguished:

  • Pain. They can be exacerbated by changes in the weather, during intense movements, or after a long stay in one position. Over time, the pain may become more pronounced.
  • Puffiness. Swelling or puffiness is usually characteristic of purulent myositis. In addition, these symptoms may be accompanied by weakness, malaise, and fever. Also, at the site of inflammation, the skin may turn red.
  • Muscle tension. It slightly limits movement and reduces pain.

Sometimes the pain disappears and does not bother a person for several days, but then returns again, and often with double strength. This is most often due to bruising of the chest, hypothermia, or infections.

After a while, the affected muscles can become weaker, and then completely decrease in size, their atrophy develops.

In order to avoid serious complications, it is necessary to limit your activity during treatment. It is not recommended to drive for a long time, play sports, including light exercises and morning runs, it is forbidden to lift weights, engage in outdoor games. It is necessary to lead a sedentary lifestyle for the period of treatment. Also, recovery will slow down the abuse of alcoholic beverages and smoking. Such habits contribute to metabolic disorders, prolonged narrowing of blood vessels, and as a result, the disease will progress.

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