Costochondritis is a painful condition of the chest wall. It is caused by inflammation in the joints between the cartilages that attach the ribs to the breastbone (sternum). Although painful, it is not a serious condition. In general, no obvious cause and settles in time. Analgesics and anti-inflammatory drugs may be used for relief of symptoms.
Costochondritis is a painful condition of the chest wall. This causes chest pain. Fortunately, there is a serious disease, but other causes of chest pain may be more severe.
To understand costochondritis, you need to know a little about the anatomy of the thoracic cage. The rib cage is a bony structure that protects the inside of the lungs. The bones are hard and solid, and tend not to bend or move. However, our lungs need to move, so you can breathe. When we take a deep breath, our chest expands also. For this to happen, the ribs need something to allow movement. Cartilage allows this. Cartilage is a softer, flexible (but strong) material found in the joints throughout the body.
Cartilage joining the ribs to the sternum (breast bone) and the sternum to the clavicle (collarbone). The joints between the ribs and cartilage of joints are called costochondral, those between the cartilages and sternum are called costosternal joints and those between the sternum and clavicle joints are called costoclavicular.
"Cost" prefix means simply related to the ribs. 'Chondr A' in relation to the cartilage and "-itis" is the medical suffix (end), meaning inflammation.
In costochondritis, inflammation in the costochondral joints, or costoclavicular costosternal (or a combination). This causes pain and tenderness, which tends to worsen with movement and pressure.
Tietze's syndrome is similar to costochondritis. The two conditions are often (incorrectly) used interchangeably. Tietze's syndrome, however, a different condition. This causes similar symptoms, is still due to inflammation, but tends to cause inflammation in the joints, or costoclavicular costosternal costochondral.
Bornholm disease is similar condition. However, it is caused by a viral illness and leads to muscle aches and pains, and chest pain. Coxsackie B virus is the most common cause of illness of Bornholm (although echovirus and Coxsackie virus may be responsible). See our separate leaflet called "Bornholm disease.
There are many causes of chest pain. Chest pain is a symptom that you should discuss with your doctor to try to establish the cause.
Note: Chest pain can have serious causes. Any chest pain severe or persistent back should be discussed with a doctor. This is especially important if you are an adult and have a history of heart disease or lung. If the pain is severe, especially if radiating to the arms or jaw, is upset, sweating and shortness of breath, call 999 for an emergency ambulance. These may be symptoms of a heart attack.
If you are young and generally healthy, then no severe chest wall pain is common. Costochondritis is an example of a condition that can cause pain in the chest wall is not serious. Because the pain of costochondritis can be quite severe, sometimes, many people who become very anxious and worried that it may be due to something more serious.
Costochondritis is often idiopathic. This is a medical term that means "of unknown cause". Thus, in many cases, is not caused.
Sometimes costochondritis can follow repeated injuries minor chest or activities that are not used to – maybe moving furniture or decorate.
No particular person at greater risk of costochondritis another. It tends to affect younger people, especially adolescents and young adults. It can affect children. People who perform repetitive motions that stress the chest wall, especially if they are used to it, could be considered a higher risk for this condition. Some studies suggest that women tend to be affected more often than men.
Individuals with fibromyalgia costochondritis tend to develop more often than others. Fibromyalgia is a chronic (long-term) that causes body aches and fatigue. (See separate leaflet called "Fibromyalgia" for more information.)
It is difficult to say how many people costochondritis. This is a relatively common problem. Probably many people that do not report their symptoms to a doctor. And, as the disease is usually of short duration, and settles spontaneously (by itself), the numbers are not known.
Some studies have estimated that between 1 and 3 in 10 people with chest pain have a musculoskeletal cause. This means that the chest pain is related to the muscles or ribs. Costochondritis is a cause of musculoskeletal chest pain.
Costochondritis cause chest pain, felt in the front of the chest. Generally, it is sharp and stabbing in nature and can be very serious. The pain worsens with movement, exercise and deep breathing. The pressure on the affected area also causes acute pain. Some people may experience severe pain. The pain is usually localized (encapsulated) within a small area, but may radiate (spread) to a wider area. The pain tends to come and go, and can be resolved by a change of posture and breathing quiet and shallow.
The most common sites of pain are near the sternum, the ribs at the 4th, 5th and 6th.
Note: no tenderness, the cause of chest pain is unlikely to be costochondritis. Remember to consult your doctor if you are unsure of the cause of their symptoms (see "Important information about chest pain" above).
Costochondritis usually diagnosed based on symptoms and examination. It is important that other causes of chest pain are discarded.
No investigations (tests) are needed to confirm costochondritis. However, investigations can be performed to rule out other causes of chest pain if the cause of the pain is unclear. Examples of these tests include an electrocardiogram (ECG – a heart trace) or a chest radiograph.
Treatments for costochondritis are analgesics (painkillers) and anti-inflammatory medications. Often only simple analgesics such as paracetamol or codeine are needed.
Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory (NSAID)) is often effective for costochondritis. Other NSAIDs are available by prescription. NSAIDs should not be taken on an empty stomach should not be used by people taking anticoagulants (such as warfarin), or by people with asthma (unless under the supervision of a doctor). If you have a history of stomach ulcers or indigestion regularly or suffer from acid reflux should avoid NSAIDs. If you develop abdominal pain, indigestion or vomiting while taking NSAIDs, such as ibuprofen, you should stop immediately and consult a doctor.
For severe cases of costochondritis not in response to analgesics and anti-inflammatory medications, steroid injections or local anesthetic drugs can be used.
In extreme cases, an intercostal nerve block can be performed (usually by a specialist in acute pain and / or anesthetics). This involves the injection of a local anesthetic around nerves painful intercostal nerve block close. The intercostal nerves transmit pain sensation in costochondritis. This type of injection temporarily interrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In cases of recurrent and severe costochondritis, a number of these shots can be given to permanently destroy the nerve that causes the pain.
Nonpharmacologic measures can be tried for pain relief in costochondritis. Examples of these techniques include heating pads, ice, transcutaneous electrical nerve stimulation (TENS), acupuncture, gentle stretching exercises and avoid sports or activities that aggravate the pain. (See separate leaflet called "TENS machines" for more information.)
The prognosis (outlook) for Costochondritis is generally very good. Most cases are mild and of short duration (usually no more than 6-8 weeks) and were better on their own – with or without medication simple. In almost all cases, the condition has completely disappeared within 6 months but in a very small number of cases it lasts longer. Costochondritis may return, but this is unlikely.
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