What Is Costochondritis?

Symptoms, Causes, Diagnosis, and Treatment

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Costochondritis is a condition that causes chest pain due to inflammation of the cartilage and bones in the rib cage. Costochondritis pain is the result of inflammation at the junction of the rib bone and breastbone (sternum). At this junction, there is cartilage joining these bones that can become irritated and inflamed.

Depending on the extent of the inflammation, costochondritis can cause pain ranging from mild to severe. Mild costochondritis can manifest with chest tenderness with touch. Severe costochondritis can cause shooting pains down the arms as well as chest pain that is severe enough to affect daily living. Costochondritis can often go away on its own but in some cases require treatment.

Symptoms of Costochondritis
Verywell / Gary Ferster

Symptoms 

Most people with costochondritis experience pain over the front of the upper chest, around the area of the breastbone. Costochondritis pain is characterized by the following features:

  • It often occurs on the left side of the breastbone.
  • The pain is typically described as sharp, aching, or pressing.
  • It typically affects more than one rib.
  • The discomfort worsens with a deep breath, cough, exercise, or activity.

Because numerous nerve branches extend from the chest, the pain may not only be centered around the breastbone but also radiate to the shoulder, arms, back, or abdomen, especially when coughing. This is referred to as referred or radiating pain.

Symptoms of costochondritis may mimic other conditions, including a heart attack

When to Call 911

Seek emergency care if you experience the following symptoms consistent with a heart attack:

  • Uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back
  • Pain or discomfort in the jaw, neck, or back
  • Pain or discomfort in one or both arms or shoulders
  • Shortness of breath
  • Dizziness, lightheadedness, or fainting
  • Weakness
  • Nausea or vomiting
  • Cold sweats

Tietze Syndrome 

A related condition called Tietze syndrome causes pain at one rib (usually the second rib) and is often accompanied by redness and swelling. The pain may come on suddenly or gradually and spread to the arms and shoulders. The pain will also worsen with physical activity, sneezing, or coughing.

Tietze syndrome differs from costochondritis because it causes swelling. Furthermore, Tietze syndrome pain will resolve without any treatment, even though the swelling may persist.

Causes

Although the exact number of people affected by costochondritis is unknown, some studies suggest that as many as 10% of people will experience musculoskeletal chest pain consistent with costochondritis. It can affect both children and adults and, for reasons unknown, is seen more often in women and Hispanics.

In adults, costochondritis is one of the more common causes of acute chest pain along with chest wall pain and reflux esophagitis, according to a 2013 study in American Family Physician.

It is often difficult to identify a single cause of costochondritis. Some of the conditions associated with costochondritis include:

People who participate in high-impact sports, perform physical labor, have allergies, or have inflammatory arthritis (such as rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis) are at an increased risk of costochondritis.

Because there is a strong connection between inflammation and heart health, people with inflammatory conditions should inform their doctors about any new chest pain.

A 2018 study in Current Pharmaceutical Design reported that heart problems are closely linked to chronic inflammatory disorders and are today the leading cause of death in people with inflammatory joint disease. 

Diagnosis 

A doctor or emergency room physician will perform a physical exam before making a diagnosis. They will ask about symptoms and family history. The doctor will also access pain levels by pressing on the rib cage and look for other signs of inflammation or infection. 

X-rays and blood work will be ordered to rule out other possible causes for your symptoms. If there are abnormal cardiac signs or respiratory symptoms, the doctor may also request an electrocardiogram (ECG) or chest X-ray to look for heart disease or a lung infection like pneumonia.

Treatment

Costochondritis usually goes away on its own, but symptoms may last for weeks or months in some people. Treatment typically focuses on pain relief. Costochondritis usually responds well to some simple interventions, including: 

  • Rest: To decrease the inflammation, you will need to avoid activities that cause pain and exacerbation of costochondritis symptoms. Exercise, deep breathing, and any strain on the muscles of the chest may worsen the symptoms and slow the healing process. As a rule of thumb, avoid or limit activities that worsen your symptoms.
  • Heat application: Applying hot packs to the chest can help relieve symptoms of costochondritis. Apply heat several times each day, especially before activities. While ice application can help with most inflammatory conditions, applying ice to the chest can be quite uncomfortable.
  • Anti-inflammatory medicationsNonsteroidal anti-inflammatory medications (such as Motrin or Advil) help with two aspects of costochondritis. Firstly, they are analgesic and help decrease pain. Secondly, these medications actively decrease inflammation, which is the primary concern with costochondritis. Check with your doctor before taking any anti-inflammatory drugs as they have potential side effects.

Normally, the treatment of costochondritis will lead to complete resolution of symptoms, but there are instances where pain from costochondritis can be chronic. In cases like these, your doctor may decide to treat you with cortisone injections after other treatments have failed to provide relief.

In addition to symptomatic treatment, the treatment of the underlying condition (such as an infection, rheumatoid arthritis, or fibromyalgia) will also usually relieve costochondritis symptoms.

A Word From Verywell 

Chest pain and pressure that involve the neck, jaw, shoulder, or arm are signs of a medical emergency and should never be ignored.

Costochondritis lasting for more than three months and is significantly affecting your quality of life should be brought to the attention of your doctor, who can determine its cause and offer treatment options. 

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  2. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.

  3. Schumann JA, Sood Tn, Parente JJ. Costochondritis. In: StatPearls. July 10, 2020.

  4. McConaghy JR, Oza RS.Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 1;87(3):177-182.

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  6. Castaneda S, Gonzalez-Juanatey C, Gonzalez-Gay MA. Inflammatory arthritis and heart disease. Curr Pharm Des. 2018;24(3):262-280. doi:10.2174/1381612824666180123102632

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