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Costochondritis

Chest wall pain; Costosternal syndrome; Costosternal chondrodynia

 

All but your lowest two ribs are connected to your breastbone by cartilage. This cartilage can become inflamed and cause pain. This condition is called costochondritis. It is a common cause of chest pain.

Causes

 

There is often no known cause of costochondritis. But it may be caused by:

  • Chest injury
  • Hard exercise or heaving lifting
  • Viral infections, such as respiratory infections
  • Strain from coughing
  • Infections after surgery or from IV drug use
  • Some types of arthritis

 

Symptoms

 

The most common symptom of costochondritis is pain and tenderness in the chest. You may feel:

  • Sharp pain at the front of your chest wall, which may move to your back or stomach
  • Increased pain when you take a deep breath or cough
  • Tenderness when you press the area where the rib joins the breastbone
  • Less pain when you stop moving and breathe quietly

 

Exams and Tests

 

Your health care provider will take your medical history and do a physical exam. Your provider will press on the area where the ribs meet the breastbone. If this area is tender and sore, costochondritis is the most likely cause of your chest pain.

A chest x-ray may be done if your symptoms are severe or do not improve with treatment.

Your provider may also order tests to rule out other conditions, such as a heart attack.

 

Treatment

 

Costochondritis most often goes away on its own in a few days or weeks, though it can take up to a few months. Treatment focuses on relieving the pain.

  • Apply hot or cold compresses.
  • Avoid activities that make the pain worse.

Pain medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may help to ease pain and swelling. You can buy these without a prescription.

  • Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
  • Do not take more than the amount recommended on the bottle or more than your provider advises you to take. Carefully read the warnings on the label before taking any medicine.

You also may take acetaminophen (Tylenol) instead, if your provider tells you it is safe to do so. People with liver disease should not take this medicine.

If your pain is severe, your provider may prescribe stronger pain medicine.

In some cases, your provider may recommend physical therapy.

 

Outlook (Prognosis)

 

Costochondritis pain usually goes away in a few days or weeks.

 

When to Contact a Medical Professional

 

Call 911 or go to your local emergency room right away if you have chest pain. The pain of costochondritis can be similar to the pain of a heart attack.

If you have already been diagnosed with costochondritis, call your provider if you have any of the following symptoms:

  • Trouble breathing
  • A high fever
  • Any signs of infection such as pus, redness, or swelling around your ribs
  • Pain that continues or gets worse after taking pain medicine
  • Sharp pain with every breath

 

Prevention

 

Because the cause is often unknown, there no known way to prevent costochondritis.

 

 

References

Buttaravoli P, Leffler SM, Costochondritis and musculoskeletal chest pain. In: Buttaravoli P, Leffler SM, eds. Minor Emergencies. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap. 62.

Imamura M, Cassius DA. Costosternal syndrome. In: Frontera WR, Silver JK, Rizzo Jr TD, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 100.

Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617-620. PMID: 19817327 www.ncbi.nlm.nih.gov/pubmed/19817327.

 
  • Ribs and lung anatomy

    Ribs and lung anatomy - illustration

    The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

    Ribs and lung anatomy

    illustration

    • Ribs and lung anatomy

      Ribs and lung anatomy - illustration

      The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

      Ribs and lung anatomy

      illustration


     

    Review Date: 11/26/2014

    Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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