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Inflammation in the chest muscle. Costochondritis: Symptoms, Causes, and Treatment – A Comprehensive Overview

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What are the symptoms of costochondritis? What causes this condition? How is costochondritis treated? Get the answers to these questions and more in this detailed article.

Understanding Costochondritis: Symptoms, Causes, and Treatment

Costochondritis is a condition that causes pain and inflammation in the front of the chest, specifically at the point where the upper ribs attach to the breastbone (sternum). This relatively harmless condition is often mistaken for a heart attack, leading to anxiety and concern. However, understanding the symptoms, causes, and treatment options for costochondritis can help alleviate these worries.

Symptoms of Costochondritis

The main symptom of costochondritis is pain and tenderness in the area where the ribs and breastbone meet. This pain is often described as pressure, aching, or a sharp sensation. The pain increases with movement and deep breathing, but decreases with rest and quiet breathing. Pressure applied directly to the affected area will also cause significant pain.

The pain is usually localized to one side of the chest, most commonly the left side, but it can also affect both sides simultaneously. Costochondritis symptoms can sometimes radiate to the back, abdomen, arm, or shoulder, adding to the confusion with heart-related conditions.

It’s important to note that the pain of a heart attack typically covers the entire chest and is often accompanied by shortness of breath, nausea, and sweating – symptoms that are not usually present with costochondritis.

Causes of Costochondritis

The exact cause of costochondritis is often unknown, but it can be associated with various factors, including:

  • Injury or trauma to the rib cage, such as from a fall or accident
  • Unusual physical activity or strain, like heavy lifting or severe coughing
  • Respiratory illnesses, such as a cold or flu
  • Underlying conditions like fibromyalgia, systemic lupus erythematosus, and ankylosing spondylitis

Costochondritis is more common in females than males and tends to affect adolescents and young adults more often.

Diagnosing Costochondritis

Costochondritis is usually diagnosed through a physical examination, where the healthcare provider will assess the nature of the symptoms and the ability to reproduce the pain by pressing on the affected area. Additional tests, such as a chest X-ray, electrocardiogram (ECG), or blood tests, may be recommended to rule out other more serious conditions.

Treating Costochondritis

In many cases, the symptoms of costochondritis resolve without the need for treatment. When treatment is required, the goal is to reduce inflammation and manage the pain. The typical treatment options include:

  • Rest and avoidance of activities that worsen the pain
  • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and pain-relieving medications such as paracetamol
  • Application of ice or heat packs to the affected area
  • Gentle stretching of the upper chest (pectoral) muscles

In more severe or persistent cases, a corticosteroid medication like hydrocortisone may be injected into the affected area to help reduce pain and inflammation. In rare instances, where the condition does not respond to conservative treatment, surgery to remove the inflamed cartilage may be necessary.

Differentiating Costochondritis from a Heart Attack

It’s important to differentiate the symptoms of costochondritis from those of a heart attack, as the sudden onset of chest pain should be assessed immediately by emergency services or a healthcare provider. The key differences are:

  • Costochondritis pain is localized to the area where the ribs and breastbone meet, while heart attack pain typically covers the entire chest
  • Costochondritis pain increases with movement and deep breathing, but decreases with rest, while heart attack pain is not affected by movement or breathing
  • Costochondritis is not usually accompanied by shortness of breath, nausea, or sweating, which are common symptoms of a heart attack

If the onset of chest pain is sudden and severe, it is crucial to seek immediate medical attention to rule out a heart attack or other life-threatening condition.

Managing Costochondritis

While costochondritis is a relatively harmless condition, the pain and discomfort it can cause can be significant. By understanding the symptoms, causes, and treatment options, individuals can take steps to manage their condition and find relief. If the pain persists or worsens, it is important to consult with a healthcare provider for proper diagnosis and management.

Costochondritis – symptoms, causes and treatment

Costochondritis is a condition that causes pain in the front of the chest. It is the result of inflammation at the point where the upper ribs attach to the breastbone (sternum).

Costochondritis is a relatively harmless condition that will usually go away without treatment. However, it can cause anxiety as its symptoms may be mistaken for a heart attack. The sudden onset of chest pain should be assessed immediately by emergency services or a doctor.

Causes

There is often no definitive cause for costochondritis. It can be associated with an injury to the rib cage or with unusual physical activity or strain (eg: heavy lifting or severe coughing). Costochondritis can occur after a respiratory illness such as a cold or flu and in people with underlying conditions including fibromyalgia, systemic lupus erythematosus and ankylosing spondylitis.

Costochondritis affects females more often than males, and more commonly occurs in adolescents and young adults.

Symptoms

The main symptoms of costochondritis are pain and tenderness at the junction of the ribs and the breastbone as a result of cartilage tissue between the bones becoming inflamed. The pain increases with movement and deep breathing and decreases with rest and quiet breathing. Pressure placed directly on the affected area will also cause significant pain.

The pain can vary in intensity but is often severe. It may be described as pressure, aching or sharp pain. It is usually located on the front of the chest, but can radiate to the back, abdomen, arm or shoulder.

The pain usually occurs on only one side of the chest, most commonly the left, but can affect both sides of the chest at the same time. Symptoms of costochondritis usually last for between one and three weeks.

Costochondritis symptoms can be mistaken for a heart attack. However, the pain of a heart attack covers the whole chest and is often accompanied by shortness of breath, nausea and sweating. If the onset of pain is sudden, contact emergency services or a doctor.

Diagnosis

A diagnosis of costochondritis can usually be made by assessing the nature of the symptoms and by the fact the pain can be reproduced by pressing on the affected area. Sometimes tests to rule out other more serious conditions may be recommended:

  • A chest X-ray
  • An electrocardiogram (ECG), which is a tracing of the heart’s electrical activity
  • Blood tests.

Treatment

Often the symptoms of costochondritis resolve without treatment. Where treatment is required, the aim is to reduce inflammation and control pain. Treatment usually consists of:

  • Rest and avoiding activities that worsen the pain
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and pain-relieving medications such as paracetamol
  • Ice and/or heat packs applied to the area
  • Gentle stretching of the upper chest (pectoral) muscles two or three times a day.

If the pain is extreme and/or prolonged, a corticosteroid medication such as hydrocortisone may be injected into the affected area to help reduce pain and inflammation. In rare cases, where the condition does not respond to medical treatment, surgery to remove the inflamed cartilage may be required.

References

Flowers, L.K. (2020). Costochondritis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/808554-overview#a4 [Accessed: 20/08/20]
NHS (2029). Costochondritis (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/costochondritis/ [Accessed: 20/08/20]
O’Toole, M.T. (Ed) (2017). Costochondritis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed). St Louis, MI: Elsevier.

Last Reviewed: August 2020

Go to our Medical Library Index Page to find information on other medical conditions.

What to Know About Strained Chest Muscles

Sharp pain and tightness in your chest. Difficulty breathing. These are just a few of the symptoms of a potential heart attack, but they can also mirror a pulled chest muscle.

A strained or pulled chest muscle is much less serious than a heart attack, but it can be quite painful.   

Read on to learn more about the causes and symptoms of muscle strains in the chest, how they are diagnosed and treated and how the symptoms differ from a heart attack.

The muscles of the chest

Your chest is made up primarily of two muscles, the pectoralis major and the pectoralis minor, as well as your intercostal muscles.

  • The pectoralis major muscles are the fan-shaped muscles that go from your armpits to the center of your breastbone, or sternum. 
  • The pectoralis minor muscles are smaller muscles under the pectoralis major that run along your ribs, just under your collarbone. 
  • The intercostal muscles run between the ribs and form the chest wall.

While it’s possible to strain the pectoralis major or pectoralis minor muscles, nearly half of all chest muscle strains occur in the intercostal muscles.

“Your intercostal muscles are responsible for helping you breathe, so straining them can feel scary, especially if you’re having trouble breathing,” said Sarah Chapman, DPT, an orthopedic clinical specialist at Banner Health in Gilbert, AZ. “Thankfully, usually all these strains are minor.”

What causes a strained chest muscle?

A pulled chest muscle can occur due to overstretching or pressure or strain on the muscles. These can be caused by a number of different situations, but are most commonly seen in athletes. 

“Many people pull their chest muscles in contact sports and other athletics that require forceful or repetitive motion, like tennis, golf, gymnastics and rowing,” Chapman said. “Similarly, if your arm is pulled back and overhead quickly or for prolonged periods of time, such as during weightlifting, it can cause a chest strain.”

The other common causes of chest muscle strains include:

  • Skipping warm-ups before sporting activities
  • Accident or injury, such as a car accident or fall
  • Lifting the wrong weight
  • Lifting while twisting, such as lifting heavy boxes off of shelves or moving furniture 
  • Hard coughing or sneezing during illness, such as bronchitis or a bad cold

What are the symptoms of strained chest muscle?

A strained chest muscle usually causes pain in the chest area that gets worse with movement or coughing.  

“You may notice pain or tenderness along the chest, tenderness when touching the injured muscle, pain with arm movements and difficulty moving the arm,” Chapman said. “There may also be bruising, swelling or muscle twitching or spasms.”

As mentioned earlier, this pain may be confused with a heart attack. However, in the case of a heart attack, there are usually other symptoms that will occur.

“With a heart attack, the pain will radiate down your arm and you may also experience nausea or vomiting, shortness of breath, dizziness, fainting, sweating, fatigue and an irregular heart rate,” Chapman said. 

Call 911 if you are experiencing symptoms of a heart attack. Do not drive yourself to the emergency room.

How is a muscle strain diagnosed?

Avoid trying to self-diagnose and treat without seeing your health care provider first. Although strains are often minor, it’s important for your provider to evaluate your symptoms and rule out something more serious, such as a broken bone.

If your pain is caused by a pulled muscle, your provider with determine if its acute (due to an injury or trauma) or chronic (due to repetitive use) and will assign a grade based on the severity of the injury.

  • Grade 1 strains (mild strains) describe mild damage to the chest that affects less than 5% of the muscle fibers.
  • Grade 2 strains describe a moderate tear to the chest that affects a higher amount of muscle fibers. This may affect mobility and strength, but the muscle isn’t fully ruptured.
  • Grade 3 strains describe a complete muscle rupture, which may require surgery to reattach the affected tendon to the bone.

What are the best ways to treat a strained chest muscle?

Most of the time, a pulled muscle is a minor injury and with proper care can heal on its own within a few weeks. 

In most mild to moderate chest muscle strains, as with all muscle strains, RICE (rest, ice, compression and elevation) is the best first line of treatment.  

Rest: Stop activity, especially those that cause you to pull your chest muscle. 
Ice: Apply ice packs or heat to the injured area to help reduce pain.
Compression: If necessary, wrap an elastic bandage to help reduce swelling. It’s important to not make the bandage too tight, as this can cause additional pain. 
Elevation: Keep your chest elevated, especially at night. You can use pillows or a wedge to help.

You may also want to consider taking over-the-counter pain relievers such as ibuprofen or acetaminophen to help with inflammation and pain.

As your pain lessens, you may slowly return to previous sports and physical activity.

For chronic muscle strains that don’t improve with rest, your provider may recommend physical therapy or changing your exercise routine to build strength in the surrounding areas. 

How can I prevent muscle strains and pulled chest muscles?

It’s important to keep the muscles in your chest stretched and strong in order to avoid injury.   

“Remember to properly warm up before performing any sport or exercise, lift heavy objects with care and avoid lifting heavy weight without proper training or practice,” Chapman said. “As well, stretch after exercise to maintain flexibility in your chest.”

Some exercises to try are a pec stretch and a doorway stretch:

  • To do a pec stretch, stand with your arms at your side and then clasp your hands together behind your back. Slowly push arms up until you feel a stretch in your chest and hold for 10 to 30 seconds.
  • To do a doorway stretch, stand by an open doorway with your arms at a 90-degree angle and palms flat on the doorframe. Slowly step forward with one foot and lean forward until you feel a stretch in the chest. Hold this for 10 to 30 seconds.

Takeaway

A strained chest muscle can be painful but it’s often a minor condition that, with some rest and proper care, can get better. 

Experiencing chest pain?

Call 911 if you have symptoms of a heart attack.

For all other chest pain:

Save your spot for a virtual or in-person urgent care visit.
Schedule an appointment with a primary care provider.

Other useful articles:

  • What’s Best for Your Fitness, Static or Dynamic Stretching?
  • How to Strengthen Your Muscles with Resistance Bands
  • How to Keep Your Muscles Strong as You Get Older
  • Everything to Know About Blood Clots in Your Veins, Heart and Lungs



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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.

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 overall 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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