Costochondritis is characterized by pain and tenderness in the cartilage that connects the ribs to the breastbone. It is the most common cause of chest wall pain and primarily affects adults over 40 years. When swelling accompanies the pain and tenderness, the condition is called Tietze syndrome. Tietze syndrome is rare and generally affects people under the age of 40.

The cause of costochondritis is not known, but it often follows chest injuries, persistent coughing, overuse of the upper body (e.g., shoulder, arm), arthritis, osteoporosis and chest surgery.

The chest pain in costochondritis may be sharp and fleeting or dull and lasting. Deep breathing and pressure to the chest worsen the pain. In Tietze syndrome, the pain occurs suddenly and may be accompanied by heat, redness and swelling.

The diagnosis of costochondritis relies upon the patient’s medical history and a physical examination. It is often a diagnosis of exclusion, meaning that it may be diagnosed after the physician rules out other conditions, such as coronary artery disease, that may be causing the symptoms. Costochondritis may accompany certain other conditions, such as arthritis, that may cause similar symptoms on their own.

Costochondritis is a diffuse pain syndrome characterized by pain, tenderness and inflammation of the costal cartilage, which connects the ribs to the sternum (breastbone). Pain is experienced in the front of the chest, and it typically goes away on its own.

Because multiple joints connecting the cartilage to the ribs or sternum are usually involved, the pain often occurs from different areas, although it may radiate widely throughout the chest. Costochondritis is not usually associated with swelling but may be associated with arthritis.

Costochondritis is the most common cause of chest pain from the chest wall (not the heart). Though it may affect any age group, it occurs most frequently in adults over age 40.

When swelling does occur, the condition is referred to as Tietze syndrome. In Tietze syndrome, localized, painful, bulbous swelling occurs on the cartilaginous joints of the chest. Generally, the costochondral joints (between the rib and the cartilage) of the second and third ribs are affected, but the costosternal (between the cartilage and sternum) and sternoclavicular (between the sternum and clavicle, or collarbone) joints may also be involved. There is no pus or other discharge associated with this swelling, and the swelling is typically unilateral (occurring on only one side).

Tietze syndrome may result in sharper, more sudden pain. It is a rare condition that primarily affects young adults under the age of 40 years, but it may occur in all age groups, including children.

The cause of costochondritis is not known. However, it commonly occurs after various injuries or conditions, including:

• Blunt chest trauma. Can include sudden force to the chest, such as from an automobile or sports accident.  Injury leading to rib fracture can also cause this problem.

• Persistent coughing. Such as that characteristic of chronic pulmonary (lung) diseases or acute respiratory infections.
  
  
• Overuse of the upper body (e.g., shoulder, arm). May result from activities such as window washing, painting or using improper lifting methods.
  
  
• Chest surgery (e.g., cardiac surgery)
  
  
• Extreme scoliosis, osteoporosis or spinal arthritis. These can cause pressure on the costochondral joints, causing costochondritis.

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.

There is no known way to prevent costochondritis, except avoiding or resolving the potential causes when possible, such as trauma or scoliosis. Avoiding severe cough and back problems can also prevent this problem.  Costochondritis typically disappears on its own, although there are rare occasions where it becomes chronic. There is no specific therapy that targets costochondritis itself. Rather, its symptoms are treated.

The first line of treatment is rest. It is important that costochondritis patients avoid any strenuous activity that may increase their pain. Activities and even deep breathing may increase the pain. Typically, the degree of rest needed relies upon the severity of the pain. Mild pain may simply require a reduction in physical activities whereas severe pain may require bed rest.

Thermotherapy may reduce pain and, in the rare cases of Tietze syndrome, decrease swelling. Heat may be applied locally for a short duration of time at regular intervals or when the pain worsens.

Medications may also help to ease the pain. In most cases, analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) are sufficient for pain reduction.  If the pain is severe, however, local anesthetics or corticosteroids, either alone or combined, may be injected into or around the pain site.

Transcutaneous electrical nerve stimulation (TENS) may also be helpful in the treatment of costochondritis. This form of electrical therapy uses small electrical impulses to inhibit pain signals. With costochondritis, TENS may be more helpful when the electrical signal is used in a crossed fashion over the area of pain. Another potential therapy is electroacupuncture, a form of acupuncture that incorporates small electrical currents.

In the rare cases when costochondritis is chronic, periodic nerve blocks may be used to block the reception of pain, and epidural corticosteroid injections may be employed to ease the pain.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about costochondritis:

1. Could costochondritis be what’s causing my chest pain?
   
   
2. What tests might I need to rule out heart conditions or other possible causes of my chest pain?
   
   
3. Is there any swelling involved in my costochondritis? If there is, does that mean I have Tietze syndrome?
   
   
4. What may have contributed to my costochondritis?
   
   
5. What other conditions may be causing my chest pain?
   
   
6. What degree of rest should I employ with my costochondritis?
   
   
7. Which over-the-counter medications can help me?
   
   
8. Would I benefit from any prescription drugs?
   
   
9. Should I try heat therapy? If so, for how long?
   
   
10. What other treatments may be appropriate for me?
    
    
11. Is there any way for me to prevent costochondritis or keep it from recurring?