Costochondritis is the result of cartilage becoming inflamed at the point where the upper ribs attach to the breastbone (sternum), which are known as the costochondral joints. The primary symptom is pain in the front of the chest.
Costochondritis can be associated with a range of causes, and is a relatively harmless condition that will usually go away without treatment. However, costochondritis pain can be a source of anxiety as it is often confused with that of a heart attack
; the sudden onset of chest pain should be assessed immediately by a doctor.
There is often no definitive cause for costochondritis. It can be associated with an injury to the rib cage or with unusual physical activity. It can also occur after a respiratory illness such as a cold or 'flu
, and in people with underlying conditions including fibromyalgia
, systemic lupus erythematosus
and ankylosing spondylitis
. Rarely, it may be caused by a bacterial or fungal infection of the costochondral joints.
Costochondritis affects females more often than males, and more commonly occurs in adolescents and young adults.
The main symptoms of costochondritis are pain and tenderness at the junction of the ribs and the breastbone. The pain increases with movement and deep breathing, and decreases with rest and quiet breathing. Pressure placed directly on the affected area will also cause significant pain.
The pain can vary in intensity but is often severe. It is commonly described as sharp, aching or pressure-like in nature. It is usually located on the front of the chest, but can radiate to the back, abdomen, arm or shoulder.
The pain usually occurs on only one side of the chest, most commonly the left, but can affect both sides of the chest at the same time. Symptoms of costochondritis usually last for between one and three weeks.
Costochondritis is similar to a condition called Tietze syndrome, which affects the same area. However, with Tietze syndrome there is swelling as well as the pain and tenderness. Swelling is not a symptom of costochondritis.
A diagnosis of costochondritis can usually be made by assessing the nature of the symptoms and by the fact the pain can be reproduced by pressing on the affected area. Sometimes tests to rule out other more serious conditions may be recommended. Tests may include:
- A chest x-ray
- An electrocardiogram (ECG) which is a tracing of the heart’s electrical activity
- Blood tests.
Often the symptoms of costochondritis resolve without treatment. Where treatment is required, the aim is to reduce inflammation and control pain. Treatment usually consists of:
- Rest and avoiding activities that worsen the pain
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac and pain relieving medications such as paracetamol
- Ice and/or heat packs applied to the area
- Gentle stretching of the upper chest (pectoral) muscles.
If the pain is extreme and/or prolonged, a corticosteroid medication such as hydrocortisone may be injected into the affected area to help reduce pain and inflammation. In rare cases, where the condition does not respond to medical treatment, surgery to remove the inflamed cartilage may be required.
Flowers, L.K. (2016). Costochondritis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/808554-overview#a4 [Accessed: 02/0917]
NHS Choices (2016). Costochondritis (Web Page). Redditch: National Health Service (NHS)
England. http://www.nhs.uk/conditions/Tietzes-syndrome/pages/introduction.aspx [Accessed: 02.09/17]
O'Toole, M.T. (Ed) (2013). Costochondritis. Mosby's Dictionary of Medicine, Nursing & Health Professions (13th ed). St Louis, MI: Elsevier Mosby.
Last Reviewed – August 2017