An Overview of Costochondritis

Prevalence, Symptoms, Causes, Diagnosis, and Treatment

In This Article

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 becomes irritated and inflamed.

Depending on the extent of the inflammation, costochondritis can be quite painful. Chest pain will range from mild to severe. Mild causes usually cause chest tenderness or some pain with touch in the chest cartilage. Severe costochondritis can cause shooting pain down the arms and chest pain that is severe enough to affect daily living and doesn’t go away despite treatment. Fortunately, costochondritis can go away on its own, but it may require treatment.

Symptoms of Costochondritis
Verywell / Gary Ferster

Prevalence

The number of people affected by costochondritis is unknown. One small study going back to 1994 found costochondritis was more common in women and Hispanics. 

A 2015 report in the journal Thorax reports the most common causes of chest are musculoskeletal conditions, with estimates in general practice ranging from 20.6% to around 46%. In emergency rooms, musculoskeletal condition causes of chest pain account for around 6.2% of the diagnoses of costochondritis. Musculoskeletal conditions affect the joints, bones, and muscles. 

Costochondritis can affect both adults and children. One 2009 report in American Family Physician reported on an adolescent outpatient clinic where 31% of adolescents had musculoskeletal pain, with costochondritis accounting for 14% of the adolescents who reported chest pain.

In adults, costochondritis is a common diagnosis of acute chest pain. Acute chest pain has a sudden onset and is related to something specific. Resolving its underlying cause can also stop costochondritis pain. 

Symptoms 

Most patients with costochondritis experience pain over the front of the upper chest (the area of the breastbone). Additionally, the pain associated with costochondritis: 

  • Often occurs on the left side of the breastbone
  • Is sharp, achy, or pressure-like
  • Will affect more than one rib
  • Worsens with a deep breath or cough
  • May radiate to the back or abdomen 

Costochondritis pain is usually worsened by activity, exercise or with taking a deep breath. These activities stretch the inflamed cartilage and touching the affected area can be extremely painful. Further, because of the many nerves that branch away from the chest, pain may be experienced in the shoulders or arms too. 

Sometimes, symptoms of costochondritis may indicate other conditions, including a heart attack. You should seek out immediate medical attention if you are experiencing chest pain that is accompanied with: 

  • Tightness, fullness, burning, or pressure in the chest
  • Searing or crushing pain radiating into the back, neck, jaw, shoulders or one or both arms
  • Pain lasting more than a few minutes, that worsens with activity, goes away and comes back, or varies in intensity
  • Shortness of breath or other breathing troubles
  • Cold sweats
  • Dizziness
  • Weakness
  • Nausea or vomiting

The above symptoms might be related to a heart attack or another heart problem, especially if there are breathing troubles and intense chest pain. Always seek immediate emergency care for abnormal and debilitating chest pain to avoid the potential for complications.

Tietze Syndrome 

A related condition called Tietze's syndrome causes pain at one rib (usually the second rib) and is often accompanied by redness and or swelling in the areas most tender. Pain may come on suddenly or gradually with Tietze’s and spread to the arms and shoulders. It will worsen with physical activity, sneezing, or coughing.

Tietze’s syndrome differs from costochondritis because it causes swelling. Further, Tietze’s pain will resolve without any treatment but the swelling will continue.

Causes and Risk Factors 

It is often difficult to identify a single cause of costochondritis. But conditions that may cause it are: 

  • Chest trauma, such as from a blunt impact during a fall or car accident
  • Physical strain during heavy lifting or strenuous exercise
  • Certain viruses or respiratory disease, including tuberculosis, a severe bacterial infection of the lungs
  • Certain types of inflammatory arthritis
  • A tumor in the costosternal joint region (area where the upper ribs attach to the breastbone) 

People who might be at risk for the development of costochondritis those who participate in high impact sports, perform physical labor, have allergies, are exposed to irritants often, and have inflammatory arthritis, such as rheumatoid arthritis (RA). 

Infection

Occasionally, costochondritis is the result of a bacterial infection. These types of chest wall infections are common in people who use IV drugs or have had surgery to the upper chest. Surgeries in the chest make the chest wall more prone to infection because of reduced flood to the area. 

Inflammatory Arthritis 

While costochondritis is not as common as inflammatory arthritis, people who have RA, ankylosing spondylitis, or psoriatic arthritis, are more likely to have costochondritis. This is because inflammatory arthritis causes inflammation over multiple joints with the ribcage joints being just as susceptible as any other joint in the body. 

Research reported in the German medical journal, Der Internist, finds up to 50% of people with chest pain have pain that is related to a musculoskeletal condition. Chest pain associated with inflammatory arthritis affects the bones and muscles of your chest wall (your rib cage). Most of the time, costochondritis pain in people with inflammatory arthritis is limited and harmless. However, sometimes, it may be an indication of a bigger problem requiring treatment. 

It is not unusual for people with inflammatory arthritis have multiple episodes of costochondritis. and most episodes resolve without treatment.

Because research shows a strong connection between inflammation and heart health, people with inflammatory conditions should inform their doctors about new chest pain. One 2018 report the journal Current Pharmaceutical Design notes cardiac problems in inflammatory joint diseases are frequent and are the leading cause of death in people with inflammatory joint disease conditions. 

Fibromyalgia

Costochondritis chest pain is a common symptom of fibromyalgia. In addition to costochondritis pain and soreness, fibromyalgia is known for causing pain throughout the body, chronic fatigue, problems with concentration and focus, depressed mood, headaches, and more

If experience chest pain, along with other symptoms of fibromyalgia, talk to your doctor about testing for fibromyalgia. Diagnosis and treatment of fibromyalgia can address all symptoms—including costochondritis pain—and help improve a person’s quality of life. 

Diagnosis 

Your 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 access pain pain levels by pressing on the rib cage. He or she will also look for signs of inflammation or infection. 

X-rays and blood work will be ordered to rule out other conditions that may be causing symptoms. Your doctor may also request an electrocardiogram (ECG or EKG) or chest X-ray to look for heart disease or other heart condition. 

Treatment

Costochondritis usually goes away on its own, but symptoms may last for weeks or even months. Overall, treatment focuses on pain relief. 

Costochondritis usually responds well to some simple treatment steps including: 

  • Rest: In order to decrease the inflammation, you will have to avoid activities that cause pain and exacerbation of the costochondritis. Exercise, deep breathing, and strain on the muscles of the chest may worsen the symptoms of pain and slow the healing process. As a general rule of thumb, avoid or limit activities that worsen your symptoms.
  • Heat Applications: Applying hot packs to the chest can be helpful in relieving symptoms of costochondritis. Apply heat several times each day, especially before activities that may irritate your symptoms. While ice application can help with most conditions of inflammation, applying ice to the chest can be quite uncomfortable.
  • Anti-Inflammatory MedicationsNonsteroidal anti-inflammatory medications (e.g. Motrin, Advil) help with two aspects of costochondritis. First, they help decrease symptoms of pain making patients more comfortable. Second, these medications help to decrease inflammation, which is the primary problem. Check with your doctor before taking any anti-inflammatory as they have potential side effects.

Normally, treatment of inflammation and pain causes costochondritis to go way, but there are instances where pain from costochondritis can be chronic. With chronic costochondritis, the pain and inflammation return even after proper treatment. Your doctor may treat with cortisone injections when other treatments have failed to provide relief over the span of several months.

With chronic costochondritis, you will need long-term treatment to make sure costochondritis does not affect routine activities and quality of life, or treatment specific to underlying condition, such as fibromyalgia or inflammatory arthritis. 

A Word From Verywell 

Chest pain and pressure that includes neck, jaw, should, or arm pain is a medical emergency—even if you have had costochondritis episodes in the past and especially if you have an inflammatory arthritis condition. Costochondritis or chest wall pain lasting more than three months and is significantly affecting your quality of life should also be brought to the attention of your doctor, who can determine its cause and treatment options. 

 

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Article Sources

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  4. Sturm C, Witte T. Musculoskeletal-related chest pain. Internist (Berl). 2017 Jan;58(1):39-46. doi:10.1007/s00108-016-0166-z


  5. 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


Additional Reading

  • Medline Plus. Costochondritis. Updated October 8, 2018. https://medlineplus.gov/ency/article/000164.htm

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Arthritis and Rheumatic Diseases. Updated April 2017. https://www.niams.nih.gov/health-topics/arthritis-rheumatic-diseases

  • Rokicki W, Rokicki M, Rydel M. What do we know about Tietze’s syndrome? Kardiochir Torakochirurgia Pol. 2018 Sep; 15(3): 180–182. doi:10.5114/kitp.2018.78443