The diagnosis of costochondritis is based on a patient’s medical history and a physical examination. The evaluation of the medical history will concentrate on patient-described symptoms. The physician will most likely press on the patient’s sternum (breastbone) during the physical examination to verify the pain.

Even though costochondritis is often a diagnosis of exclusion, meaning the physician may first have to rule out other conditions, pain with pressure over the joints usually indicates costochondritis. Diagnostic tests typically look for signs of other conditions rather than any signs of costochondritis itself. In some cases (e.g., certain injuries or infections), other conditions may have played a part in causing the costochondritis. In other cases (e.g., osteoporosis, arthritis) these conditions may exist with and complicate costochondritis.

In any circumstance, these conditions need to be treated first. In many instances, the costochondritis or symptoms suggestive of costochondritis will then disappear. If the symptoms persist after treatment of other conditions, the symptoms will then be addressed.

Conditions that may be tested for or considered include:

• Injuries and infections. Trauma to the sternum and ribs, including subsequent fractures, and dislocations and separation of the ribs, cartilage and sternum may lead to costochondritis or symptoms suggestive of the condition. Infections may also result in costochondritis or its symptoms.
  

  

• Pneumonia and other respiratory conditions. The persistent cough of these conditions may lead to costochondritis. Further, many of these conditions alone may cause symptoms suggestive of costochondritis.
  
  
• Arthritis and osteoporosis. These conditions may be associated with costochondritis or may cause similar symptoms on their own.
  
  
• Transitory benign chest wall pain (TBCWP). Like costochondritis, this common noncardiac condition affects the wall of the chest. Unlike costochondritis, however, it is most common in people under age 40, especially children.
  
  
• Heart attack. When the chest pain of costochondritis is severe, it may mimic that of a heart attack. However, the location of the pain is different. Costochondritis causes the chest pain when pressure is applied to the sternum or the ribs near the sternum. The pain of a heart attack is typically more widespread and the chest wall usually is not tender.
  
  
• Coronary artery disease and upper gastrointestinal conditions. Heart disease and conditions that affect the upper digestive tract, such as heartburn or esophageal spasms, may lead to symptoms suggestive of costochondritis. These conditions need to be ruled out before costochondritis is diagnosed.
  
  
• Fibromyalgia and myofascial pain syndrome. These chronic pain conditions can cause muscle pain in the chest and elsewhere.
  
  
• Gout and pseudogout. These forms of arthritis can affect the costochondral and other joints.
  
  
• Malignancy. Some forms of cancer may mimic the chest pain characteristic of costochondritis. These cancers need to be ruled out before costochondritis is diagnosed.

There is no test to detect costochondritis, but a variety of tests may be performed to rule out other potential underlying conditions, including:

• Complete blood count (CBC). This routine blood test measures the composition of blood cells within the body. The test provides physicians with important information about the white blood cells, red blood cells and platelets in a person’s blood and can indicate infection.  
  
  
• X-ray. This painless imaging test can be used in diagnosis of a wide range of painful conditions, including fractures.
  
  
• MRI (magnetic resonance imaging). MRI is a noninvasive or minimally test that produces clear cross-sectional or three-dimensional images of the body’s tissues.