Costochondritis Information | Mount Sinai

Chest wall pain; Costosternal syndrome; Costosternal chondrodynia; Chest pain – costochondritis

All but your lowest 2 ribs are connected to your breastbone by cartilage. This cartilage can become inflamed and cause pain. This condition is called costochondritis. It is a common cause of chest pain.

The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

Causes

There is often no known cause of costochondritis. But it may be caused by:

• Chest injury
• Hard exercise or heavy lifting
• Viral infections, such as respiratory infections
• Strain from coughing
• Infections after surgery or from IV drug use
• Some types of arthritis

Symptoms

The most common symptoms of costochondritis are pain and tenderness in the chest. You may feel:

• Sharp pain at the front of your chest wall, which may move to your back or stomach
• Increased pain when you take a deep breath or cough
• Tenderness when you press the area where the rib joins the breastbone
• Less pain when you stop moving and breathe quietly

Exams and Tests

Your health care provider will take your medical history and do a physical exam. The area where the ribs meet the breastbone is checked. If this area is tender and sore, costochondritis is the most likely cause of your chest pain.

A chest x-ray may be done if your symptoms are severe or do not improve with treatment.

Your provider may also order tests to rule out other conditions, such as a heart attack.

Treatment

Costochondritis most often goes away on its own in a few days or weeks. It can also take up to a few months. Treatment focuses on relieving the pain.

• Apply hot or cold compresses.
• Avoid activities that make the pain worse.

Pain medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may help to ease pain and swelling. You can buy these without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Take the dose as advised by the provider. Do not take more than the amount recommended on the bottle. Carefully read the warnings on the label before taking any medicine.

You may also take acetaminophen (Tylenol) instead, if your provider tells you it is safe to do so. People with liver disease should not take this medicine.

If your pain is severe, your provider may prescribe stronger pain medicine.

In some cases, your provider may recommend physical therapy.

Outlook (Prognosis)

Costochondritis pain often goes away in a few days or weeks.

When to Contact a Medical Professional

Call 911 or the local emergency number, or go to your local emergency room right away if you have chest pain. The pain of costochondritis can be similar to the pain of a heart attack.

If you have already been diagnosed with costochondritis, contact your provider if you have any of the following symptoms:

• Trouble breathing
• A high fever
• Any signs of infection such as pus, redness, or swelling around your ribs
• Pain that continues or gets worse after taking pain medicine
• Sharp pain with every breath

Prevention

Because the cause is often unknown, there is no known way to prevent costochondritis.

Crasto JA, Vaswani RS, Pauyo T, Musahl V. Overview of sport-specific injuries. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Hanak JA. Tietze syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 117.

Kurz J. Costosternal syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 101.

Last reviewed on: 10/20/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Symptoms, Causes, Tests, and Treatment

Costochondritis is an inflammation of the cartilage in the rib cage. It can happen due to infection, injury, and other health conditions.

This condition usually affects the cartilage where the upper ribs attach to the breastbone, also known as the sternum, in an area known as the costosternal joint or costosternal junction.

Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel slightly tender or some pain when you push on the area.

More severe cases may get worse with certain movements as well as with deep breaths. The condition often goes away within a few weeks or months, but some cases may require treatment.

People with costochondritis often experience chest pain in the upper and middle rib area on either side of the breastbone. This pain can gradually increase over time, or come on suddenly.

Additional symptoms can include:

• pain that becomes worse when lying down
• pain that becomes worse when there’s pressure on your chest, like when you wear a seatbelt
• pain that intensifies with coughing or deep breaths
• pain that increases with physical activity

It’s important to note that symptoms like chest tightness and radiating pain can indicate other conditions, including a heart attack. Seek immediate medical care if you’re experiencing persistent, intense chest pain.

The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:

• trauma to the chest, such as blunt impact from a car accident or fall
• physical strain from activities, such as heavy lifting and strenuous exercise
• certain viruses or respiratory conditions, such as tuberculosis, that can cause joint inflammation
• severe coughing

There’s some research that suggests costochondritis occurs more often in women, especially those who are athletes. You may also be at a higher risk for this condition if you:

• participate in high-impact activities
• recently had a physical trauma or fall that affected the chest area
• have allergies and are frequently exposed to irritants

While there’s no test to diagnose costochondritis, your doctor will most likely ask a series of questions and do a series of tests to determine the source of your chest pain.

Lab tests

Typically, lab tests aren’t needed to diagnose costochondritis, but depending on your personal health history, your doctor may do some tests to see if your chest pain could be due to other issues like pneumonia or coronary heart disease.

X-rays and ECGs

Your doctor may want you to get an X-ray to make sure there’s nothing abnormal going out with your lungs.

If you’re dealing with costochondritis, your X-ray should look normal. They may also recommend an electrocardiogram (ECG) to make sure your heart isn’t the cause of your chest pain.

Many times, diagnosing costochondritis is a matter of eliminating other possible, more serious causes.

See your doctor right away if you have trouble breathing or are feeling intense chest pain.

Always seek immediate emergency care when you have abnormal and debilitating pain in your chest. It can indicate something serious, such as a heart attack.

Getting care as soon as possible limits the possibility of complications, especially if an underlying issue is causing your costochondritis.

Costochondritis can be treated in several ways.

Most cases of costochondritis are treated with over-the-counter medications. If your pain is mild to moderate, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).

Your doctor may also recommend:

• prescription-strength NSAIDs
• oral steroids or injection of a steroid into the area involved
• transcutaneous electrical nerve stimulation (TENS), which is a mild electric current that is delivered to the area via a small, battery-powered device

Lifestyle changes

Your doctor may tell you to make permanent lifestyle changes if you have persistent or chronic costochondritis.

Some types of exercise can aggravate this condition, including rowing and weightlifting. Manual labor may also have a negative effect.

Your doctor may also recommend:

• rest
• physical therapy
• hot or cold therapy using a heating pad and ice

Normally, treatment of the inflammation and pain causes costochondritis to eventually go away on its own.

If you have chronic costochondritis, the pain may persist or return — even with treatment — when you exercise or engage in certain activities. In these cases, you may need to seek long-term care to make sure that costochondritis doesn’t affect your quality of life and ability to take part in daily activities.

Pains associated with costochondritis can indicate other issues. Chest pain can often mean that you’re having heart or lung issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or have pneumonia.

The chest pain associated with costochondritis can be a symptom of fibromyalgia. With fibromyalgia, you may experience soreness in your chest in addition to:

• pain throughout your body
• fatigue and inability to rest due to pain
• difficulty focusing or concentrating
• feelings of depression
• headaches

If you experience chest pains along with these other symptoms, talk with your doctor about getting tested for fibromyalgia. Understanding this condition can help you address the symptoms and ensure that it doesn’t interrupt your daily life.

Costochondritis is caused by inflammation and typically presents as chest pain that gets worse with certain movements or pressure. This condition usually isn’t persistent. In many cases, costochondritis goes away on its own.

Mild cases of costochondritis may disappear after a few days. Chronic cases can last for weeks or more, but most cases don’t last any longer than a year.

To lower your chances of developing persistent costochondritis, carry and lift heavy loads properly. Try doing fewer high-impact exercises or manual labor, when possible.

Seek medical attention immediately if you experience chest pain while performing any of these activities.

Costochondritis – Medical center “Lіko-Med”

Publication date
October 3, 2018

Rubric
Diseases

What is costochondritis?

Costochondritis is an inflammation of the cartilage that connects the ribs and sternum. The inflammatory process causes pain in the chest on one or both sides. Certain diseases can lead to costochondritis, such as arthritis and fibromyalgia, trauma, and a viral or bacterial infection of the respiratory tract. However, the cause of the disease is usually unknown. Costochondritis is considered harmless. Very often it is mistaken for a heart attack. The disease is more common among women than among men. As a rule, the inflammation goes away on its own in a few days or weeks.

What to expect?

The pain of costochondritis can be severe, and the disease is often mistaken for a heart attack or lung disease. The inflammation usually goes away within a few days or weeks on its own. Pain relievers, ice packs, or heat can help relieve pain.

Distribution.

Costochondritis is diagnosed in 14% of adolescents and 30% of adults who complain of chest pain.

Risk factors .

– Belonging to the female sex.

– Over forty years of age.

Treatment.

Treatment of costochondritis includes:

– Applying heat or cold to the affected area.

– Use of anti-inflammatory drugs.

– Avoidance of activities that aggravate pain.

– Corticosteroid injections – for severe pain.

What can you do yourself?

Costochondritis is usually treated at home with anti-inflammatory drugs. It is useful to apply ice or heat to the area of ​​​​inflammation. If this does not help, see a doctor to assess the condition.

What makes it worse?

– Injuries.

– Twisting movements.

– With deep breaths.

– Sleeping on an uncomfortable bed with no pillow or mattress.

When to see a doctor?

See a doctor if:

– you wake up with pain;

– breathing problems;

– fever or signs of infection.

Chest pain that radiates to the left arm, along with sweating, nausea, or general chest pain that is not concentrated in one area, may be a sign of a heart attack and requires emergency care.

What to ask the doctor?

1. How often do I need to have a health check-up?

2. Do I need to have any tests or x-rays?

3. What symptoms should you seek medical attention for?

4. When will the condition improve?

5. What is the long-term prognosis of the disease?

Diagnosis.

Costochondritis is diagnosed based on the patient’s medical history and physical examination.

Costochondritis: symptoms, causes, risk factors and treatment

Photo: pixabay com

Costochondritis is also known as costosternal chondrodynia, costosternal syndrome, or chest wall pain syndrome. This is a condition associated with inflammation/swelling of the cartilage that connects the rib to the sternum or sternum. However, the inflammation is accompanied by a sharp pain in the left half of the sternum, which radiates to the shoulder and arm.

Because the pain of costochondritis is in the chest area, you may mistake it for a heart attack.

The condition is harmless and usually resolves without any treatment. But for severe pain, the treatment strategy is symptomatic and based on pain relief.

Symptoms of costochondritis

• Chest pain associated with costochondritis usually occurs after exercise, injury or respiratory infections.
• Sharp pain in the chest, usually on the left, at the junction of the ribs with the sternum.
• Pain when coughing or taking a deep breath.
• Pain on pressure on costal joints.
• If costochondritis is due to a postoperative infection, there will be redness, swelling, and purulent discharge at the surgical site.
• Your doctor will examine you for tenderness or swelling along your breastbone. He/she may ask you to move your arms or chest in a certain way to cause costochondritic pain.

There are no specific or confirmatory laboratory or imaging tests for costochondritis. But to rule out other serious chest, lung, and airway conditions, your doctor may order certain tests, such as a chest x-ray and an echocardiogram (ECG).

If you have had a history of chest surgery or are at risk for heart disease, your doctor may recommend testing to determine if an infection at the surgery site is causing the pain. They will look for:

• Redness, swelling and purulent discharge at the site of the operation.
• Check white blood cells (white blood cell count) to confirm infection.
• Recommend chest scan with gallium.
• Recommend a chest x-ray to rule out pneumonia.

Causes of costochondritis

Although the exact causes of costochondritis are unknown, the following conditions can cause costochondritis pain:

• Vigorous arm exercise
• Repeated or multiple minor chest injuries
• Arthritis. Costochondritis may be the initial sign of arthritis, rheumatoid arthritis, or ankylosing spondylitis.
• A tumor that has moved from the joints and settled in the chest.
• Virus-mediated respiratory infections.
• Upper chest wall surgery

Risk factors for costochondritis

Chest pain associated with costochondritis is commonly seen in children and adolescents. About 10-30% of chest pain in children is caused by costochondritis. It can be seen that 12-14 years is the peak age for this condition.

Women over 40 are also more prone to costochondritis.

Treatment of costochondritis

It is important to see a doctor if you experience chest pain. In order to find the optimal treatment, it is necessary to make the correct diagnosis.

Your doctor may first prescribe over-the-counter (OTC) medicines to relieve chest pain and swelling. These medications include NSAIDs such as ibuprofen, naproxen, and acetaminophen.

If NSAIDs are not sufficient to relieve pain, local anesthesia and injection of steroids at the site of pain may be given.
For extremely unbearable pain, drugs such as hydrocodone or oxycodone can help.

If these medicines do not help with pain, your doctor may give you an injection of corticosteroids at the site of pain.
Other drugs such as the tricyclic antidepressants amitriptyline and antiepileptic drugs such as gabapentin may also help treat costochondritis pain. However, they also have other side effects.

Infectious costochondritis is treated with intravenous antibiotics.

Home remedies for costochondritis

Once you have been diagnosed with costochondritis by your doctor, you can also manage costochondritis-related chest pain at home:

• Taking over-the-counter pain relievers.
• Get enough sleep and rest your arms and ribs.
• Avoid excessive exercise and heavy lifting.
• Apply an ice pack to your chest at the site of pain.