What is costochondritis? What are the symptoms of costochondritis? How is costochondritis diagnosed and treated? Get comprehensive insights on this condition that causes chest pain.

Understanding Costochondritis: An Overview

Costochondritis is a condition characterized by inflammation in the cartilage that connects the ribs to the sternum. This inflammation can lead to pain and discomfort in the chest wall, particularly where the ribs meet the sternum. Costochondritis is a relatively common condition, and it is more prevalent in young women, especially those with young children.

Causes of Costochondritis

The primary cause of costochondritis is inflammation in the cartilage of the rib cage. This inflammation can be triggered by a variety of factors, including physical stress, repetitive movements, or underlying medical conditions such as arthritis or fibromyalgia. Women, particularly those with young children, may be more prone to developing costochondritis due to the physical demands placed on their musculoskeletal system.

Symptoms of Costochondritis

The main symptom of costochondritis is chest pain. This pain is typically localized to the area where the ribs meet the sternum and can be either sharp or dull in nature. The pain may worsen with chest wall movement, deep breathing, sneezing, or coughing. It is important to note that chest pain should not be ignored, as it may also indicate a more serious underlying condition.

Diagnosing Costochondritis

To diagnose costochondritis, the healthcare provider will perform a thorough physical examination, including a careful history and palpation of the affected area. They may also order imaging tests, such as X-rays or bone scans, to rule out other potential causes of the chest pain. However, costochondritis itself will not be visible on these tests, and the diagnosis is primarily based on the patient’s symptoms and the healthcare provider’s physical examination findings.

Treatment for Costochondritis

The treatment for costochondritis typically involves a combination of conservative measures, such as the use of ice packs, over-the-counter anti-inflammatory medications, and rest. In more severe or persistent cases, the healthcare provider may recommend the use of prescription anti-inflammatory medications or even injections of corticosteroids to reduce the inflammation and alleviate the pain. In some cases, physical therapy or other supportive measures may also be recommended.

Preventing Costochondritis

To prevent the recurrence of costochondritis, it is important to engage in proper strength training to build the muscles of the chest wall, which can help stabilize the joints and reduce the risk of injury. Additionally, it is important to avoid physical activities that may overload the musculoskeletal system, and to promptly address any flare-ups with rest, ice, and anti-inflammatory medications.

Can costochondritis be confused with other conditions?

Yes, costochondritis can sometimes be confused with other conditions that cause chest pain, such as Tietze’s syndrome or slipping rib syndrome. It is important to work with a healthcare provider to ensure an accurate diagnosis and appropriate treatment.

How long does it take for costochondritis to heal?

Costochondritis is generally considered a self-limiting condition, meaning it will typically resolve on its own within a few months. However, in some cases, it may become chronic or recur, especially if the underlying cause is not properly addressed.

Can costochondritis be caused by a specific injury?

Yes, costochondritis can sometimes be triggered by a specific injury or physical activity that places excessive stress on the chest wall. This is particularly common in young women who may have physical responsibilities that exceed their musculoskeletal strength.

What are the risk factors for developing costochondritis?

The primary risk factors for developing costochondritis include:
– Being a young woman, especially with young children
– Engaging in physical activities or responsibilities that exceed one’s musculoskeletal strength
– Underlying conditions such as arthritis or fibromyalgia
– Repeated episodes of chest wall stress or injury

Can costochondritis be prevented?

Yes, there are steps that can be taken to help prevent the development or recurrence of costochondritis, including:
– Engaging in regular strength training to build the muscles of the chest wall
– Avoiding physical activities or responsibilities that may overload the musculoskeletal system
– Promptly addressing any flare-ups with rest, ice, and anti-inflammatory medications

When should someone seek medical attention for chest pain?

Chest pain should never be ignored, as it may indicate a serious underlying condition. If you experience chest pain, it is important to seek medical attention, especially if the pain is accompanied by shortness of breath, dizziness, or other concerning symptoms. A healthcare provider can help determine the cause of the chest pain and provide appropriate treatment.

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Costochondritis

COSTOCHONDRITIS

Overview

Costochondritis is an inflammation in the cartilage of the rib cage. It usually occurs where the ribs meet the bony plate across the front of the chest called the sternum. Between each rib and the sternum is a small segment of cartilage that forms the joints. These joints can get inflamed with arthritis, which can spread across the chest wall. Chest wall movement, including deep breathing, sneezing or coughing increases the pain. The disorder is more common in young women, especially those with young children. Young mothers frequently stress their chest wall while holding their child in their arms. In addition, women frequently have physical responsibilities in which they are not strong enough to safely carry out. Increased physical demands placed upon a relatively weak musculoskeletal system can lead to costochondritis.

Diagnosis

The patient with costochondritis will have chest pain. It can be either to the left or right of the sternum. Chest pain should not to be ignored because it may indicate a serious problem with the heart or lungs. The doctor will perform a careful history and physical exam, and possibly order X-rays or blood tests to rule out serious problems. If costochondritis is present, the doctor will discover tenderness over the joints and ribs of the chest wall. Unfortunately, costochondritis itself will not show up on any X-ray, but in extreme cases a bone scan may be positive.

Treatment

Most sudden flare-ups can be treated with an ice pack and the use of oral anti- inflammatory drugs such as aspirin or Motrin. Usually over 48 hours, the patient will improve and can become active. As long as the patient doesn’t over utilize his or her arms, the chest pain will stay at a minimal level. However, it is not always practical to limit our physical activities. Indeed, many young women have the responsibilities of a job and running a household. In this situation, if the pain fails to resolve, injections with powerful anti-inflammatory drugs are used to clear up the underlying inflammation of the joints. It may be necessary to inject multiple joints. In this situation, the injections can be given under a light intravenous sedation, with a drug like Valium. This insures the patient will be comfortable during the procedure. Costochondritis is usually a one-time event, although in some patients it can become chronic.

Prevention

If you are prone to repeat bouts of costochondritis, try to avoid physical activities that seriously overload your musculoskeletal system. Engage in proper strength training to build the muscles of the chest wall, which will stabilize the joints. If you feel a bout of costochondritis coming on, rest, apply ice and take oral anti-inflammatory agents. If inflammation can be decreased early on, the pain will be minimized.

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Costochondritis: Rib Pain – Gemini Osteopathy

Blog

• 16/12/2022
• Osteopathy

Costochondritis causes pain in the front of the ribs. The name refers to inflammation of the cartilage between a rib and the breastbone (sternum).

Chest pain can indicate a respiratory or cardiovascular emergency and should first be investigated by a doctor. Please go to A&E if your breathing is affected, or there are signs of a serious problem.

Features of Costochondritis

This condition most often affects the upper 5 ribs. Pain at the joint where the rib meets the sternum causes either a sharp or dull pain, which may be worse on taking a deep breath. Typically, the area over the joint will be tender.

The onset of symptoms can be sudden or gradual, and may be aggravated by some arm and upper body movements. Often it seems to begin for no apparent reason, but it might follow intense exercise or an illness that causes a lot of coughing.

Prognosis for Costochondritis

Fortunately, the condition is considered self limiting. The NHS expects it to resolve on its own within a few months.

As it can be associated with RA or fibromyalgia, it may recur or be more persistent. If your symptoms come and go a lot over the course of your recovery, or it takes more than a few months to resolve, it’s time to look at other factors.

Other conditions can present similarly, so these should also be ruled out if symptoms are not improving as expected:

• Tietze’s Syndrome is similar, but a separate disease. The key distinguishing feature is swelling and heat at the painful point. Blood tests will show raised inflammatory markers.
• Slipping Rib Syndrome: the pain here is further down the chest, as the ribs with a less direct connection to the sternum are affected. They become hypermobile, and the ends can catch and irritate a nerve.

Managing Costochondritis

The root cause of the pain in costochondritis is inflammation. You can speak to your GP or pharmacist about anti-inflammatory medications that are appropriate for you, or try a cool compress over the painful area. Because these joints are close to the skin, you might find that you can make a big difference with a bag of frozen peas. Make sure you don’t leave it in place for more than 10 minutes at a time, and don’t apply the bag directly to skin- use a tea towel or keep a layer of clothing in between.

Your osteopath can support you through your episodes of costochondritis by ensuring the rest of the body is working well. Inflammation in the joint at the front of a rib might change the way the joint at the back works. This could cause mid-back pain and stiffness, potentially with secondary effects elsewhere.

As slouching and some exercises can make symptoms worse, we can also work with you to alter these behaviours. Gentle exercises to strengthen the upper back and make it more comfortable to sit up straight can be helpful. If your pain is aggravated by exercises that you do in the gym or as part of a sport, we can look to alter form, intensity, or frequency to reduce the irritation on the joints in question.

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Tietze’s syndrome – causes, symptoms, diagnosis and treatment

Tietze’s syndrome – a disease from the group of chondropathy, accompanied by aseptic inflammation of one or more upper costal cartilages in the area of ​​their articulation with the sternum. It is manifested by local soreness at the site of the lesion, aggravated by pressure, palpation and deep breathing. As a rule, it occurs for no apparent reason, in some cases there may be a connection with physical exertion, operations in the chest area, etc. The diagnosis is made on the basis of complaints and examination data after the exclusion of more serious pathologies using X-ray, ultrasound, CT and others. research. Treatment is usually conservative: NSAIDs, blockade, physiotherapy.

General information

Tietze’s syndrome (costal cartilage syndrome, costal chondritis) is an aseptic inflammation of one or more costal cartilages in the area of ​​their connection with the sternum. Usually suffer II-III, less often – I and IV ribs. As a rule, the process captures 1-2, less often – 3-4 ribs. In 80% of cases, a unilateral lesion is noted. The disease is accompanied by swelling and pain, sometimes radiating to the arm or chest. The reasons for the development are not fully understood. The treatment is conservative, the outcome is favorable.

The disease usually develops at the age of 20-40 years, although an earlier onset has been recorded – at the age of 12-14 years. According to most authors, men and women suffer equally often, but some researchers note that in adulthood, Tietze’s syndrome is more often detected in women.

Tietze’s syndrome

Causes

Although the causes of Tietze’s syndrome are currently not fully understood, there are several theories that explain the mechanism of development of this disease. The most popular is the traumatic theory. Many patients with Tietze’s syndrome are athletes, perform heavy physical labor, suffer from acute or chronic illness with a severe hacking cough, or have a history of rib injury.

Supporters of this theory believe that due to direct trauma, permanent microtrauma or overload of the shoulder girdle, cartilage is damaged, microfractures occur at the border of the bone and cartilage parts. This causes irritation of the perichondrium, from the poorly differentiated cells of which a new cartilage tissue is formed, somewhat different from normal. Excess cartilage tissue compresses the nerve fibers and causes pain. Currently, the traumatic theory is the most recognized in the scientific world and has the most evidence.

Infectious-allergic theory. The followers of this theory find a connection between the development of Tietze’s syndrome and acute respiratory diseases that had been transferred shortly before, which provoked a decrease in immunity. This theory may also be supported by a more frequent development of the disease in people suffering from drug dependence, as well as in patients who have undergone chest surgery in the recent past.

Alimentary-dystrophic theory. It is assumed that degenerative cartilage disorders arise as a result of a violation of the metabolism of calcium, vitamins of groups C and B. This hypothesis was expressed by Tietze himself, who first described this syndrome in 1921, however, at present, the theory is classified as doubtful, since it is not supported by objective data.

Symptoms

Patients complain of acute or gradually increasing pain, which is localized in the upper chest, near the sternum. Pain is usually unilateral, aggravated by deep breathing, coughing, sneezing and movement, can be given to the shoulder, arm or chest on the side of the lesion. Sometimes the pain syndrome is short-term, however, more often it is permanent, long-lasting and worries the patient for years. There is an alternation of exacerbations and remissions. The general condition during the period of exacerbation does not suffer. On examination, pronounced local pain on palpation and pressure is determined. A dense, clear swelling of a fusiform shape 3-4 cm in size is revealed.

Diagnosis

The diagnosis of Tietze’s syndrome is made by a specialist in traumatology and orthopedics on the basis of clinical findings, after excluding other diseases that could cause chest pain. And one of the main symptoms confirming the diagnosis is the presence of a characteristic clear and dense swelling, which is not detected in any other disease.

In the course of differential diagnosis, acute trauma, diseases of the cardiovascular system and internal organs that could cause similar symptoms, including various infectious diseases and the already mentioned malignant neoplasms, are excluded. If necessary, the patient is referred for blood tests, MRI, CT, ultrasound and other studies.

An x-ray examination over time reveals subtle changes in the cartilage structure. At the initial stages, the pathology is not determined. After some time, thickening and premature calcification of the cartilage, the appearance of bone and calcareous clumps along its edges becomes noticeable. A few weeks later, small periosteal deposits appear at the anterior ends of the bony part of the affected ribs, causing the rib to thicken slightly and the intercostal space to narrow. In the later stages, a fusion of cartilaginous and bone segments of the ribs is found, deforming osteoarthritis of the costal-sternal joints and bone growths.

X-ray in Tietze’s syndrome has no independent significance at the time of diagnosis, since the first changes on radiographs become noticeable only after 2-3 months from the onset of the disease. However, this study plays an important role in the exclusion of all kinds of malignant tumors, both primary and metastatic.

In doubtful cases, computed tomography is indicated, which allows to detect changes characteristic of Tietze’s syndrome at an earlier stage. Also, in the course of differential diagnosis with malignant neoplasms, Tc and Ga scanning and a puncture biopsy can be performed, in which degenerative changes in the cartilage and the absence of tumor elements are determined.

Particular concern due to its wide prevalence in adult patients is caused by possible cardiovascular diseases and, in the first place, coronary heart disease. IHD is characterized by short-term pain (on average, an angina attack lasts 10-15 minutes), while with Tietze’s syndrome, pain can persist for hours, days, and even weeks. Unlike Tietze’s syndrome, in ischemic disease, pain syndrome is stopped by drugs from the nitroglycerin group. For the final exclusion of cardiovascular pathology, a number of analyzes and instrumental studies (ECG, etc.) are performed.

Tietze’s syndrome also has to be differentiated from rheumatic diseases (fibrositis, spondyloarthritis, rheumatoid arthritis) and local cartilage and sternum lesions (costochondritis and xifoidalgia). To rule out rheumatic diseases, a number of special tests are performed. Costochondritis is indicated by the absence of hypertrophy of the costal cartilage, xifoidalgia – pain in the area of ​​the xiphoid process of the sternum that increases with pressure.

In some cases, Tietze’s syndrome in its clinical picture may resemble intercostal neuralgia (both of which are characterized by prolonged pain, aggravated by movement, sneezing, coughing and deep breathing). In favor of Tietze’s syndrome, less pronounced pain syndrome, the presence of dense swelling in the area of ​​costal cartilages and the absence of a zone of numbness along the intercostal space testify. There are no changes in the biochemical composition of the blood, general blood and urine tests in Tietze’s syndrome. Immune reactions are normal.

Treatment of Tietze syndrome

Treatment by orthopedic traumatologists. Patients are under outpatient observation, hospitalization, as a rule, is not required. Patients are prescribed topical treatment using ointments and gels containing non-steroidal anti-inflammatory drugs. Compresses with dimexide are also used. With severe pain syndrome, NSAIDs and painkillers for oral administration are prescribed.

With persistent pain combined with signs of inflammation that cannot be stopped by taking analgesics and non-steroidal anti-inflammatory drugs, a good effect is provided by the introduction of novocaine with hydrocortisone and hyaluronidase into the affected area (blockade of the pectoral muscle). In addition, physiotherapy, reflexology and manual therapy are used.

Extremely rarely, in case of persistent disease and ineffectiveness of conservative therapy, surgical treatment is required, which consists in subperiosteal resection of the rib. Surgery is performed under general or local anesthesia in a hospital setting.

causes, symptoms, diagnosis and treatment

Tietze’s syndrome is also called costal chondritis. This disease is an inflammation of the cartilage tissue in the place where the rib articulates with the body of the sternum. Although the disease is common, in medicine it is not yet well understood. However, it is not difficult to diagnose Tietze’s syndrome, therefore, with a timely visit to a doctor, the disease can be cured in a short time.

Causes and symptoms

Costal chondritis was described by the German physician Alexander Tietze in the 1920s. In most cases, the disease affects the cartilaginous tissues of the upper rib in the handle of the sternum. Inflammation of the cartilage of several ribs at once is rare. Chondritis is diagnosed in both men and women over 20 years of age. However, among middle-aged people, the disease is more often detected in women. Rarely, costal chondritis occurs in children and adolescents.

Sometimes doctors cannot determine the exact cause of costal chondritis. Tietze himself considered the cause of the pathology to be malnutrition, due to which the metabolism in the body is disturbed and cartilage tissues become thinner. However, modern doctors do not support this theory. The most common causes of inflammatory processes in cartilaginous tissues are:

• injuries, fractures and other injuries of the chest;
• physical overload;
• complications after infectious diseases;
• the presence of diseases such as bronchial asthma, tuberculosis, diabetes mellitus.

Symptoms of the disease are always the same – acute pain when moving the body, coughing, sneezing, laughing, taking a deep breath. Sometimes the pain in the chest is permanent, radiates to the shoulder, arm, and does not cease to torment the patient for years. But usually pain at rest does not occur. On palpation, the pain intensifies, a small swelling of 2–3 cm in size is felt. In some cases, periods of exacerbation and remission may alternate, misleading the person that the disease has receded.

Some patients with costal chondritis are observed:

• fever;
• shortness of breath;
• weakness;
• lack of appetite;
• redness in the affected area.

Diagnosis of the disease

On the basis of clinical data, the doctor makes a diagnosis of Tietze’s syndrome. From other diseases that can develop in the chest area, costal chondritis is distinguished by a characteristic dense swelling that is detected by palpation. However, for a more detailed study of a specific case of the disease, the doctor may refer the patient to an ultrasound scan and a blood test. According to the results of these studies, the cause of chondritis becomes clear:

• whether it was caused by infectious diseases;
• chronic diseases;
• microtrauma;
• other lesions.

Radiography plays an important role in the diagnosis of Tietze’s syndrome. According to x-rays, doctors manage to track the process of changes in cartilage tissues. But for this, X-ray examinations should be carried out every 2-3 months. In addition, radiography helps eliminate the risk of developing a malignant tumor.

If the doctor has any doubts, he may order an MRI or a CT scan. These studies help to study the affected area in detail, identify pathology in the early stages, exclude the presence of other diseases, such as coronary heart disease, rheumatoid arthritis, intercostal neuralgia, rheumatic fever, spondyloarthritis, angina pectoris, etc.

If a malignant neoplasm is suspected, the patient is prescribed a needle biopsy.

Methods of treatment

Although costal chondritis is little studied, it is treated successfully. In most cases, it is possible to completely eliminate inflammation without the risk of recurrence. There are 2 ways to treat Tietze’s syndrome:

• conservative;
• surgical.

The conservative method of treatment is characterized by the use of almost the entire list of drugs used for the treatment of joint diseases. As a rule, treatment begins with taking anti-inflammatory drugs. They are prescribed in the form of injections to relieve pain and eliminate other symptoms of the disease. With a long course, anti-inflammatory drugs are prescribed in the form of tablets with a non-aggressive effect on the stomach.

Various anti-inflammatory ointments and gels can be used as additional treatments. To quickly restore damaged tissues, it is useful to use warming ointments. Usually the course of treatment lasts 3-4 weeks. At this time, the patient should treat infectious diseases in a timely manner, avoid excessive physical exertion, hypothermia and chest injuries.

Surgical treatment of costal chondritis is rare. The operation is necessary in advanced cases, when a deformation has occurred in the costal joint that limits the life of a person. In such cases, medications will only help prevent another exacerbation of the disease, but will not cure it completely.

During the operation, those parts of the tissues that have undergone deformation are removed. The periosteum and surrounding vessels remain intact so that the soft tissues fully grow together and do not interfere with the person’s usual activity. But not always it comes to the operation. In some cases, a therapeutic puncture is performed, when painkillers and anti-inflammatory drugs are injected into the affected area with a special needle. In the photo, this procedure seems unpleasant. But in fact, the therapeutic puncture does not cause pain and effectively relieves inflammation.

Recovery and prevention

The positive effects of treatment largely depend on the recovery period. To avoid recurrence, the patient undergoes a course of warming physiotherapy procedures, which:

• accelerate the process of tissue regeneration;
• improve blood circulation;
• normalize metabolism.

Such curative measures include:

• paraffin applications;
• electrophoresis;
• laser procedures;
• diadynamic therapy.

As a rule, full recovery of the body can be achieved in 2-3 weeks.

In the recovery period, treatment with folk remedies will be useful. For this, various medicinal herbs are used, preparing tinctures, ointments and decoctions based on them. Means can be both rubbed into the affected area of ​​​​the chest, and taken orally.

However, all home prescriptions must be approved by your healthcare provider.