Costochondritis

What is costochondritis?

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown, but may happen from increased activity involving the arms.

   Costochondritis (with unknown cause) is a common cause of chest pain in children and adolescents. It accounts for 10% to 30% of all chest pain in children. Annually, doctors evaluate about 650,000 cases of chest pain in young people ages 10 to 21. The peak age for the condition is ages 12-14.

   Costochondritis is also considered as a possible diagnosis for adults who have chest pain. Chest pain in adults is considered a potentially serious sign of a heart problem by most doctors until proven otherwise. Chest pain in adults usually leads to a battery of tests to rule out heart attack and heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor will diagnose costochondritis as the cause of your chest pain. It is important, however, for adults with chest pain to be examined and tested for heart disease before being diagnosed with costochondritis. It is often difficult to distinguish between the two without further testing. The condition affects females more than males (70% versus 30%). Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.

   Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by noting the following:

  • Tietze syndrome is rare.
  • It usually comes on abruptly, with chest pain radiating to your arms or shoulder and lasting several weeks.
  • Tietze syndrome is accompanied by a localized swelling at the painful area (the junction of the ribs and breastbone).

What are the causes?

Costochondritis is an inflammatory process but usually has no definite cause. Repeated minor trauma to the chest wall, overuse of the arms, or viral respiratory infections can commonly cause chest pain due to costochondritis. Occasionally, costochondritis as a result of bacterial infections can occur in people who use IV drugs or who have had surgery to their upper chest. After surgery, the cartilage can become more prone to infection, because of reduced blood flow in the region that has been operated on.

Different types of infectious diseases can cause costochondritis.

  • Viral: Costochondritis commonly occurs with viral respiratory infections because of the inflammation of the area from the viral infection itself, or from straining from coughing.
  • Bacterial: Costochondritis may occur after surgery and be caused by bacterial infections.
  • Fungal: Fungal infections are rare causes of costochondritis.

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?

Costochondritis usually goes away on its own, although it might last for several weeks or longer. Treatment focuses on pain relief.

Medications

Your doctor might recommend:

  • Non-steroidal anti-inflammatory drugs. Although certain medications, such as ibuprofen (Motrin IB) or naproxen sodium (Aleve) are available over the counter, your doctor might prescribe stronger varieties of these non-steroidal anti-inflammatory medications. Side effects might include damage to your stomach lining and kidneys.
  • Narcotics. If your pain is severe, your doctor might prescribe medications containing codeine, such as hydrocodone/acetaminophen (Vicodin, Norco) or oxycodone/acetaminophen (Tylox, Roxicet, Percocet). Narcotics can be habit-forming.
  • Antidepressants. Tricyclic antidepressants, such as amitriptyline, are often used to control chronic pain — especially if it’s keeping you awake at night.
  • Anti-seizure drugs. The epilepsy medication gabapentin (Neurontin) also has proved successful in controlling chronic pain.

Therapy

Physical therapy treatments might include:

  • Stretching exercises. Gentle stretching exercises for the chest muscles may be helpful.
  • Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. The current might interrupt or mask pain signals, preventing them from reaching your brain.

Surgical and other procedures

If conservative measures don’t work, your doctor might suggest injecting numbing medication and a corticosteroid directly into the painful joint.

 

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