Costochondritis

What Is Costochondritis?

Costochondritis is inflammation of the areas where your upper ribs join with the cartilage that holds them to your breastbone. These areas are called costochondral junctions. The condition causes chest pain, but it’s typically harmless and usually goes away without any treatment. But any chest pain in adults should be taken seriously, so you should be examined and tested for heart disease.

A rare condition calledTietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by the following:

  • Tietze syndrome usually comes on all of a sudden, with chest pain spreading to your arms or shoulder and lasting several weeks.

  • Tietze syndrome causes swelling at the painful area (where your ribs and breastbone meet).​​​​​​​

Costochondritis Causes

Doctors don’t know exactly why costochondritis happens, but they do know that some things can lead to it: 

  • Repeated minor trauma to your chest wall
  • Overuse of your arms
  • Arthritis. Costochondritis can sometimes be a sign of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other conditions that affect your cartilage.
  • Tumors. These can move from joints and other parts of your body and settle in your chest.
  • Respiratory infections caused by viruses 
  • Bacterial infections, especially in people who use IV drugs or have had surgery near their upper chest 
  • Fungal infections (in rare cases)

Costochondritis Symptoms

Chest pain linked to costochondritis usually comes on after exercise, minor trauma, or an upper respiratory infection.

  • Sharp pain in the front of  your chest, near where your breastbone and ribs meet, typically on the left side. It may spread to your back or belly.
  • Pain when you take a deep breath or cough. It gets better when you stop moving or your breathing is quieter.
  • Tenderness when you press on your rib joints. If you don’t have this tenderness, you probably don’t have costochondritis.
  •  If costochondritis happens because of an infection after surgery, you’ll have redness, swelling, or pus discharge at the site of the surgery.

Call your doctor if you have any of the following:

  • Trouble breathing
  • High fever
  • Signs of infection such as redness, pus, and increased swelling at the rib joints
  • Continuing or worsening pain despite medication
  • Nausea
  • Sweating
  • Dizziness

Go to a hospital's emergency room if you have a hard time breathing or any of the following. They’re not usually caused by costochondritis:

  • High fever that doesn’t get better with fever reducers such as acetaminophen or ibuprofen
  • Signs of infection at the tender spot, such as pus, redness, increased pain, and swelling
  • Persistent chest pain of any type when you also have nausea, sweating, or pain in your left arm. These may be signs of a heart attack. If you’re not sure what’s causing your chest pain, go to the emergency room.

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Costochondritis Risk Factors

Costochondritis 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 see about 650,000 cases of chest pain in people ages 10 to 21. The peak age for the condition is ages 12-14.

Kids who often carry heavy book bags over one shoulder can be more likely to develop costochondritis.

In adults, costochondritis affects women more than men (70% vs. 30%). 

Costochondritis Diagnosis

There is no specific test for diagnosing costochondritis. To rule out a more serious cause of your chest pain related to your heart or lungs, your doctor will probably start with tests like an echocardiogram (EKG), chest X-rays, and blood test for heart damage, among others. 

If those tests come back normal, they’ll likely see if you have tenderness in any of your rib joints, usually over the fourth to sixth ribs.

If you’ve had sternum (breastbone) surgery or are at risk for heart disease, they may recommend getting a test to see if infection is the cause of your chest pain. Doctors will:

  • Look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery
  • Recommend a more sophisticated imaging study of the chest called agallium scan, which will show an increase in the radioactive material gallium 
  • Check your white blood cell count to see if it is high, a sign of infection
  • Recommend a chest X-ray ifpneumonia might be a cause of your chest pain

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Costochondritis Treatment and Home Remedies

Home Remedies for Costochondritis

These home remedies may provide relief from costochondritis:

  • Over-the-counter  pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen as needed
  • Using local heat or ice to relieve pain
  • Avoiding unnecessary exercise or activities that make the symptoms worse; avoiding contact sports until there is improvement in symptoms, and then returning to normal activities only as tolerated
  • Doing stretching exercises

Medications for Costochondritis

Your doctor may suggest the following:

  • Prescription-strength NSAIDs.
  • A local anesthetic and steroid injection in the area that is tender if normal activities become very painful and the pain doesn’t get better with medicine.
  • Narcotics like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) can help with extreme pain, but, as with any narcotics, there’s danger of becoming addicted to them.
  • Steroids. Your doctor can give you a corticosteroid shot directly into a painful joint, but that’s considered something of a last resort.
  • Tricyclic antidepressants or cyclic antidepressants likeamitriptyline can help ease pain, but they also can have side effects, like weight gain and drowsiness. 
  • Antiseizure drugs, usually gabapentin (Neurontin), are typically used to treat epilepsy, but they also may help with costochondritis.
  • Infectious (bacterial or fungal) costochondritis should be treated with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another 2 to 3 weeks. You should see a doctor during recovery, and then once a year. 

Surgery for Costochondritis

You may need surgery to remove the sore cartilage if other treatments don’t help. Your doctor can refer you to a surgeon.

Costochondritis Prevention

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Costochondritis Outlook

Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgery, but recovery may take a long time.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on June 16, 2020

Sources

SOURCES:

Johns Hopkins All Children’s Hospital: “Costochondritis.”

Mayo Clinic: “Costochondritis.”

eMedicineHealth: "Costochondritis."

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