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.

Top Picks

Inflammation of the mammary glands

Related articles:

Ultrasound of the mammary glands

The structure of the mammary glands

Diagnosis of diseases of the mammary glands

Treatment of diseases of the mammary glands

Major diseases of the mammary glands

Mastitis

Mastitis treatment

Diagnosis of mastitis

Prevention of mastitis

Pain in the breast

Inflammation of the mammary glands

Inflammation of the mammary glands, or in other words mastitis, is a disease in which an inflammatory process forms in the mammary gland. Often this disease occurs in women of reproductive age.

The occurrence of this inflammation most often occurs in women during lactation. Mastitis is accompanied by pain and fever. Now let’s talk in more detail about the symptoms of the disease.

Symptoms of breast inflammation

The symptoms of mastitis can vary. It all depends on what form of mastitis and the degree of its neglect. Indeed, in the initial stages of the disease, only chest pain may appear. And after a few days, an increase in body temperature, bursting of the chest and its redness may be added. But the main and main symptoms of inflammation of the mammary glands are:

• The chest becomes painful to the touch. The pain can be very severe;
• There may be lumps in the chest. The nature of the compaction varies and depends on the area in which the mastitis occurs;
• Swelling is formed in the area of ​​inflammation and redness of that place appears;
• Inflammation of the breast often results in fever and swollen lymph nodes. If no action is taken, the temperature will rise;
• When feeding a child, a woman experiences unpleasant pain.

If you are breastfeeding and notice tightness and pain in your breasts, do not hesitate. After all, mastitis is a rather serious disease, which, if not treated in time, will lead to bad consequences. That is why it is so important to contact us in time for early diagnosis and detection of inflammatory processes in the chest.

Inflammation of the glands in women

Often this disease occurs during the period when a woman is breastfeeding. This is due to the fact that the child does not drink the milk that is produced by the mother, or the young mother incorrectly attaches the child to the breast. Also, mastitis can develop due to trauma to the nipple. Through cracks and wounds, the infection enters the chest and causes an inflammatory process.

The initial stage of inflammation quickly becomes acute. This is due to the fact that in the postpartum period, the woman’s immunity is weakened and cannot fully resist infections. Often this disease occurs in women who have given birth for the first time. In women who have not given birth, hormonal imbalances can become the causes of inflammation.

Causes of inflammation

Inflammation of the mammary glands can occur due to various factors. But the main reasons that lead to the occurrence of this disease include:

• Getting into the mammary gland of various infections that penetrate through cracks in the nipples;
• Hypothermia of the whole body, as a result of which the chest is also supercooled;
• Education in the mammary glands of various tumors. They can be either benign or malignant;
• Lactostasis, which the woman did not finish or started;
• Various injuries of the mammary glands.

Whatever the cause of mastitis, it is important to identify it in time and get rid of this unpleasant disease. This requires the help of qualified doctors. This is exactly what you can get from our center. Our doctors will offer you a full range of breast diagnostic services. An ultrasound of the breast is mandatory, as this study gives very accurate results and information.

After passing a full examination, passing all the tests, an experienced doctor will evaluate them and prescribe you an effective treatment that will not harm you or your baby. You can safely continue breastfeeding, and most importantly get rid of this unpleasant disease.

Inflammation of the mammary gland treatment – Modern methods of treatment at the MHC

Inflammation of the mammary gland or mastitis in 80-90% of cases is associated with pregnancy and childbirth. This is a benign process in the tissues of the gland, limited (abscess) or diffuse (phlegmon), which requires timely intervention and antibiotics. Inflammation of the mammary gland requires timely and immediate treatment, it can be carried out at the medical center of I. Medvedev.

Inflammation of the mammary gland: general questions

Mastitis is a non-specific inflammation of the breast tissue, associated mainly with childbirth and lactation, or with mastopathy (non-lactational mastitis). Rarely, mastitis is chronic, usually acute.

Causes of breast inflammation:

• milk stasis
• incomplete emptying of the gland during feeding
• cracked nipples
• improper breastfeeding
• poor hygiene
• secretion stagnation
• Calcifications in the ducts

Symptoms of mastitis

Classic signs of breast inflammation: pain, redness, swelling, fever, dysfunction.

• engorgement, edema
• skin reddening
• bursting pains
• infiltrate
• pus in milk
• skin changes by type of gangrene, infiltrate

Inflammation is usually associated with impaired patency of the ducts and the addition of a secondary infection, which gets from the nipple into the gland tissue through the milk ducts and lymphatic vessels. With a normal level of immunity, the process is limited by a capsule, an abscess is formed, with immunodeficiency, pus spreads through the tissues – a phlegmonous form.

Diagnosis of inflammation of the mammary gland (mastitis)

Usually, mastitis is quite easy to diagnose by the patient herself, but it is still worth contacting a specialist. In the medical center of I. Medvedev, receptions and emergency care are provided 363 days a year, and the treatment is based on minimally invasive and conservative methods.

If the patient has breast pain, treatment begins with diagnosis. It includes:

• inspection and palpation
• Breast ultrasound
• if necessary, puncture with histology of the contents of the punctate

Treatment

At first, when mastitis is not yet purulent, but serous, cold compresses, frequent pumping (or feeding), antibiotics can be completely dispensed with if the inflammation lasts longer than a day. Preferred in this case are penicillins, including inhibitor-protected ones. When a woman has inflammation of the breast, the treatment is different, depending on the stage of the process.

If an abscess has already formed, there is no point in prolonging it. Abscess puncture under ultrasound control can resolve the process conservatively, if not, then it is necessary to perform resection of the gland segment in which the abscess lies, with drainage of the cavity.

As for breastfeeding, it is contraindicated if there is pus in the milk, if not, then no restrictions are imposed.

Inflammation of the mammary gland and hyperplasia

Dishormonal processes, with a predominance of estrogens, also cause pain and discomfort in the gland, but, unlike mastitis, this is a non-inflammatory process. Breast hyperplasia treatment is fundamentally different from mastitis, here hormone therapy comes to the fore. Hyperplasia – proliferation of gland tissues with the formation of cysts, swelling of cells, discharge from the nipple. It refers to mastopathy, fibroadenoma and adenomas.

An important role in this disease is played by increased synthesis of prolactin, therefore drugs suppressing its production are widely used, including herbal medicine.