Chest Wall Pain

Chest wall pain (Costochondritis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions.

What are the symptoms?

Chest pain associated with costochondritis is usually preceded by exercise, minor trauma, or an upper respiratory infection.

  • The pain, which may be dull, usually will be sharp and located on your front chest wall. It may radiate to your back or abdomen and is more common on your left side.
  • There can be pain with a deep breath or cough.
  • The most common sites of pain are your fourth, fifth, and sixth ribs. This pain increases as you move your trunk or take deep breaths. Conversely, it decreases as your movement stops or with quiet breathing.
  • The reproducible tenderness you feel when you press on the rib joints (costochondral junctions) is a constant feature of costochondritis. Without this tenderness, a diagnosis of costochondritis is unlikely.
  • Tietze syndrome, on the other hand, exhibits swellings at the rib-cartilage junction. Costochondritis has no noticeable swelling. Neither condition involves pus or abscess formation.
  • Tietze syndrome usually affects the junctions at the second and third ribs. The swelling may last for several months. The syndrome can develop as a complication of surgery on your sternum months to years after the operation.
  • When costochondritis occurs as a result of infection after surgery, you will see redness, swelling, or pus discharge at the site of the surgery.

What are the treatments?

The treatments for costochondritis are painkillers and anti-inflammatory medications. Often, just simple painkillers such as paracetamol or codeine are needed.

Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory drug, or NSAID) that is often effective for costochondritis. Other NSAIDs are available on prescription.

For severe cases of costochondritis not responding to painkillers and anti-inflammatory medication, injections of steroids or local anaesthetic medicines may be used.

In extreme cases, an intercostal nerve block can be performed (usually by a doctor specializing in acute pain and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs, to block the nearby intercostal nerve. The intercostal nerves transmit the painful sensation in costochondritis. This sort of injection temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In repeated, severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.

Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:

  • Heat pads.
  • Ice application.
  • Transcutaneous electrical nerve stimulation (TENS).
  • Acupuncture.
  • Gentle stretching exercises.
  • Avoidance of sports or activities that worsen the pain.
  • Physiotherapy or chiropractic therapy.

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