Costochondritis

Definition

Costochondritis (kos-toe-KHON-dri-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain in the costosternal joint — where your ribs and breastbone are joined by rubbery cartilage. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.

Your doctor might refer to costochondritis by other names, including chest wall pain, costosternal syndrome and costosternal chondrodynia. When the pain of costochondritis is accompanied by swelling, it's referred to as Tietze syndrome.

Most cases of costochondritis have no apparent cause. In these cases, treatment focuses on easing your pain while you wait for costochondritis to improve on its own.

Bones and joints associated with costochondritis

Bones and joints associated with costochondritis

Costosternal joints connect your ribs to your breastbone (sternum), forming your rib cage. Costochondritis is characterized by inflammation and pain in the costosternal joints. ...

Symptoms

Costochondritis is the most common cause of chest pain originating in the chest wall.

Symptoms include:

• Pain and tenderness in the locations where your ribs attach to your breastbone (costosternal joints)
• Often sharp pain, though also dull and gnawing pain
• Location often on left side of breastbone, but possible on either side of chest

Other costochondritis symptoms may include:

• Pain when taking deep breaths
• Pain when coughing
• Difficulty breathing

When to see a doctor
Make an appointment to see your doctor if self-care measures aren't helping your pain or if your pain is worsening.

Costochondritis pain is often mistaken for heart attack pain. The pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area. Heart attack pain usually feels as if it's coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself. Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant.

Don't waste time, though, trying to distinguish between the two if you're experiencing unexplained and persistent chest pain. Chest pain is an emergency — seek medical attention right away.

Bones and joints associated with costochondritis

Bones and joints associated with costochondritis

Costosternal joints connect your ribs to your breastbone (sternum), forming your rib cage. Costochondritis is characterized by inflammation and pain in the costosternal joints. ...

Causes

Doctors don't know what causes most cases of costochondritis. Only some cases of costochondritis have a clear cause. Those causes include:

• Injury. A blow to the chest could cause costochondritis.
• Physical strain. Heavy lifting and strenuous exercise have been linked to costochondritis.
• Upper respiratory illness. An infection that produces sneezing or a cough may produce costochondritis.
• Infection. Infection can develop in the costosternal joint, causing pain.
• Fibromyalgia. Recurring costochondritis could be a symptom of fibromyalgia. People with fibromyalgia often have several tender spots. The upper part of the breastbone is a common tender spot.
• Pain from other areas of your body. Pain signals can sometimes be misinterpreted by your brain, causing pain in places far away from where the problem occurs. Your doctor might refer to this as "referred pain." Pain in your chest can sometimes be caused by problems with the bones in your spine compressing the nerves.

Risk factors

Costochondritis occurs most often in women and in people older than 40. However, costochondritis can affect anyone, including infants and children.

Preparing for your appointment

Call 911 or emergency medical help or have someone drive you to an emergency room if you experience new or unexplained chest pain or pressure that lasts for more than a few moments. Don't waste any time for fear of embarrassment if it's not a heart attack. Even if there's another cause for your chest pain, you need to be seen right away.

If you have less alarming pain or tenderness in your breastbone that isn't improving, make an appointment with your doctor.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down your symptoms, including when they started and how often they occur.
• Make a list of your key medical information, including any recent infectious illnesses and other health conditions with which you've been diagnosed. Also list the names of any medications, vitamins or supplements you're taking.
• Note any recent injuries or strenuous exercise that preceded your chest pain.
• Write down key personal information, including any major stressors in your life.
• Take a family member or friend along, if possible. Someone who accompanies you can help remember information that you missed or forgot.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Below are some basic questions to ask a doctor who is examining you for possible costochondritis. If any additional questions occur to you during your visit, don't hesitate to ask.

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• What treatment approach do you recommend, if any?
• What self-care steps are likely to help improve my symptoms?
• Do I need to follow any activity restrictions?
• What new signs or symptoms should I watch for at home?
• How soon do you expect my symptoms will resolve?
• Should I see a specialist?

Don't hesitate to ask any additional questions that occur to you during your medical evaluation.

What to expect from the doctor
A doctor who sees you for chest pain may ask:

• What are your symptoms?
• When did you first begin experiencing these symptoms?
• Have your symptoms gotten worse over time?
• Where is your pain located?
• Does anything else seem to make your pain worse?
• Does anything seem to make your pain better?
• Are you having any difficulty breathing?
• Do your symptoms include fatigue or any problems related to sleep?
• Do your symptoms include fever or chills?
• Does exercise or physical exertion make your symptoms worse?
• Have you had any recent respiratory infections?
• Have you had any recent injuries to your chest?
• Were your symptoms preceded by strenuous physical activity?
• Have you been diagnosed with any other medical conditions?
• Have you recently experienced a significant amount of stress or change?
• Are you aware of any history of heart problems in your family?
• What medications are you currently taking, including vitamins and supplements?

What you can do in the meantime
In the time leading up to your appointment, try self-care measures at home. You may find relief from a heating pad and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).

Until your doctor evaluates you, avoid activities that worsen your pain and rest as much as possible.

Tests and diagnosis

Your doctor will conduct a physical exam to diagnose costochondritis. He or she will ask you to describe your pain and what influences it. The pain of costochondritis can be very similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. Your doctor will feel along your breastbone for areas of tenderness or swelling.

Costochondritis generally can't be seen on chest X-rays or other imaging tests used to see inside your body. Sometimes your doctor orders these tests or others to rule out other conditions.

Treatments and drugs

Costochondritis usually goes away on its own and is short-lived, although in some cases it may last for several months or longer.

To ease your pain until it fades, your doctor may recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
• Antidepressants, specifically a category of medicines called tricyclic antidepressants, if pain is making it difficult to sleep at night
• Muscle relaxants, which can also help ease pain

Lifestyle and home remedies

It can be frustrating to know that there's little your doctor can do to treat your costochondritis. But you can take self-care measures to make yourself more comfortable, which can give you a greater sense of control over your condition. To help relieve the pain of costochondritis, try to:

• Rest. Avoid activities that make your pain worse.
• Exercise. It may seem contradictory to rest, but gentle exercises, such as walking or swimming, can improve your mood and keep your body healthy. Don't overdo it, and stop if exercise increases your pain.
• Use a heating pad. Apply a heating pad to the painful area several times a day. Keep the heat on a low setting.

Once your pain is gone, continue taking it easy. Slowly work your way back to your normal activities.

Prevention

Although the cause of costochondritis is often unknown, there's some evidence that children who carry a heavy school bag, especially over one shoulder, are at increased risk of this condition. Upper respiratory infections, heavy lifting and strenuous exercise also may be linked to costochondritis.

Common-sense preventive steps that may reduce the risk of costochondritis and protect you and your family's overall health include:

• Encourage your child to use school bags properly. Make sure your child's bag is not so heavy that your child's shoulders slump, and show your child how to carry the bag appropriately.
• Avoid activities that seem to trigger costochondritis-like pain. If chest pain and tenderness seem to result from physical exertion, ask your doctor to provide safe guidelines for your exercise program and for lifting.
• Take steps to prevent respiratory infection. Wash your hands thoroughly and often, avoid sharing drinking glasses or utensils with others and limit your exposure to people who are ill.