What Is Costochondritis? Symptoms & Treatment

A painful condition involving the costochondral joint in the chest cavity – costochondritis describes inflammation of the cartilage that joins the ribs to the sternum (breastbone). The cartilage attached to the ribs is both tough and flexible, allowing movement during respiration whilst at the same time cushioning the joint.

Inflammation of the cartilage of one or more ribs in the sternum, can cause painful symptoms in the chest wall which may also radiate to a wider area of the chest.chostochondritis pain location

Costochondritis and Tieze's Syndrome

The term Costochondritis is often used interchangeably with a much rarer condition known as Tietze's Syndrome – both diseases produce very similar symptoms and involve inflammation of the costochrondral joint; however, Tieze's syndrome generally causes swelling of the cartilage as well as the painful symptoms, and typically affects young adults under the age of 40 years. Costochondritis is a relatively more common condition with no swelling – generally affecting adults over the age of 40 years.

Symptoms

Chest Pain

This is the most commonly reported symptom and can be characterised by anything from mild to severe sharp stabbing pains, depending on the individual.

Chest pain may worsen with:

  • deep breathing, coughing or sneezing
  • any type of physical activity
  • any pressure applied to the chest such as a seatbelt or tight clothing
  • lying down

Feelings of tenderness in the chest

Sensations of pressure or constraint in the chest area

Emergency Symptoms

The chest pain caused by costochondritis can begin gradually, although in some cases it occurs very suddenly, making it easy to confuse with other life threatening illnesses associated with sudden chest pain, such as heart attacks. The chest pain felt during a heart attack may be of similar nature to that of costochondritis; however, heart attack is generally accompanied by chest pain and other symptoms such as: pain felt elsewhere in the body (often in the left arm), feelings of light headedness/dizziness, nausea, difficulty breathing, sweating and severe feelings of anxiety and ill-being.

Note: any severe or persistent chest pain requires medical attention

Causes of Costochondritis

Costochondritis is idiopathic – in some cases however, the inflammation – which is the body's natural response to infection and irritation, may be linked to the following:

  • Infections
    • Respiratory Tract Infections
    • Wound Infection
  • Viruses
  • Arthritis
  • Injury/trauma caused by physical impact e.g. car accident
  • Physical strain from exercise
  • Severe coughing
  • Tumour

Diagnosis

The first steps of diagnosis will be a detailed physical examination, and evaluation of all symptoms, along with a review of the patient's medical history.

To confirm the diagnosis and rule out any other possible conditions, further tests will be required, these may include:

  • Chest X-Ray
  • Electrocardiogram ECG (records the rhythms and electrical activity of the heart)
  • Blood Test (to diagnose inflammation or infection)
  • MRI or CT Scans

Treatment

Costochondritis usually settles by itself without treatment, although some cases may be prolonged causing chronic pain, for these cases there are various forms of treatment available.

Pain Medication

Over the counter medications - paracetamol and anti-inflammatories such as ibuprofen or aspirin may provide relief for milder symptoms.

A physician may prescribe stronger medication such as:

  • prescription only painkillers
  • anti-depressants

Corticosteroid Injections

Corticosteroid injections are injected into and around the costochondral joint, these steroid injections are designed to reduce inflammation and the painful symptoms associated with it.

Physiotherapy

A trained physiotherapist can help devise a specific plan of stretches and exercise, as well as providing advice on helpful changes to your daily physical routine.

TENS Therapy

Transcutaneous electrical nerve stimulation – a mild electrical current is delivered to the painful area, reducing pain signals travelling to the spinal cord and brain.

Pain Management

The symptoms associated with chronic pain can create something of a vicious circle. Any form of chronic pain can be extremely debilitating, interrupting many daily routines; the inability to carry out daily tasks and routines, due to the pain they cause, in turn, can lead to feelings of frustration, depression and isolation. Severe pain can make it difficult to concentrate on tasks, affecting the individual's performance in the workplace; it is also very tiring and can impinge on restorative sleep, resulting in chronic fatigue. This has its own range of negative side effects such as low moods, irritability, depression, anxiety and difficulty with concentration.

Pain management clinicians do not understand pain purely in biological terms, they adopt the biopsychosocial approach which considers the biological, psychological and social aspects of the patient's life and their complex interaction in the patient's condition. By using this approach, the pain management consultant can devise a fully comprehensive, individually tailored patient plan which may incorporate a multidisciplinary team, including physicians, psychologists, physiotherapists and other health professionals to help not only treat the painful symptoms themselves, but also the negative side effects and thought processes they may produce.

Vector illustration credit: Vecteezy

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