What Is Costochondritis?

Costochondritis is a condition that causes chest pain because of inflammation of the cartilage and bones in the rib cage.

Costochondritis pain is the result of inflammation where the rib bone meets the breastbone (sternum). This is where cartilage joining these bones can become irritated and inflamed.

Depending on the extent of the inflammation, costochondritis can cause pain ranging from mild to severe. Mild costochondritis may cause only tenderness over the affected area in the chest. Severe costochondritis can cause shooting pains down the arms as well as in the chest.

Costochondritis will often go away on its own, but in some cases requires medical treatment.

This article explains the symptoms, causes, diagnosis, and treatment of costochondritis. It also addresses a similar condition known as Tietze syndrome.

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.
• It is typically described as sharp, aching, or pressing.
• It typically affects more than one rib.
• It intensifies with a deep breath, cough, exercise, or activity.

Many nerve branches fan out from the chest, so the pain may also spread to the shoulder, arms, back, or abdomen, especially when coughing. This is called referred or radiating pain.

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

Tietze Syndrome 

A related and rare condition called Tietze syndrome causes pain at one rib (usually the second rib). Often, it is accompanied by redness and swelling.

The pain may come on suddenly 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. Also, the disorder 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, according to a 2013 study.

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

• Bacterial infections after surgery or from intravenous drug use
• Chest injury
• Fibromyalgia
• Hard exercise or heavy lifting
• Inflammatory arthritis
• Strain from coughing
• Viral infections, such as respiratory tract infections

There is a strong connection between inflammation and heart health. So people with inflammatory conditions should inform their healthcare provider about any new chest pain.

Diagnosis 

A doctor or emergency room medical professional treating someone with chest pain often performs a physical exam before making a diagnosis. They will ask about symptoms and family history.

They will also assess pain levels by pressing on the rib cage and looking for other signs of inflammation or infection. X-rays and bloodwork may be ordered to rule out other possible causes for costochondritis symptoms. 

If there are abnormal cardiac signs or respiratory symptoms, the healthcare provider 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. Some people deal with the symptoms for weeks or months, however. Costochondritis usually responds well to: 

• Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications (NSAIDs), such as Motrin or Advil, help with two aspects of costochondritis. First, they are analgesic and help decrease pain. Second, they decrease inflammation. Check with your healthcare provider before taking any anti-inflammatory drugs. They can have side effects.
• Heat application: Applying hot packs to the chest can help relieve symptoms of costochondritis. Apply heat several times each day, especially before activities. While applying ice can help with most inflammatory conditions, applying it to the chest can be uncomfortable.
• Rest: It's not a cure-all, but rest can do wonders to relieve pain. At the same time, limiting or avoiding physical activities can ease discomfort, too.

Normally, treating costochondritis will completely clear up the symptoms. However, there are cases where pain from costochondritis can be persistent. In cases like these, your healthcare provider may decide to treat you with cortisone injections.

Summary

Chest pain often leads people to think they're having a heart attack, but this usually is not the case. Sometimes, it's costochondritis, whose symptoms include sharp or aching pain on the left side of the breastbone that gets worse when you cough, take a deep breath, or exercise. Costochondritis often goes away on its own, but anti-inflammatory medications, heat, and rest can help with symptoms in the meantime.

A Word From Verywell 

Chest pain and pressure that involve the neck, jaw, shoulder, or arm are signs of a medical emergency. You should respond by calling 911. If your costochondritis lasts more than three months and/or significantly affects the quality of your life, consult your healthcare provider. They can offer the best treatment options for you.