Costochondritis is a localized pain in the anterior (front) chest wall.
Occurring in patients of any age, costochondritis means pain at the junction of the bony and cartilaginous parts of a rib—usually the second, third, fourth, or fifth rib—that is highly localized. Sometimes, but not always, there is accompanying swelling and inflammation, a condition preferably referred to as Tietze’s syndrome. Neither costochondritis nor Tietze’s syndrome is a serious disease, but their symptoms mimic those of several dangerous conditions.
Causes
There is no known specific cause, but several types of arthritis may affect the costochondral joints.
Risk Factors
The following factors increase your chance of developing costochondritis. If you have any of these risk factors, tell your doctor:
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Rheumatoid arthritis
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Ankylosing spondylitis
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Reiter’s syndrome
Symptoms
If you experience any of these symptoms, do not assume it is due to costochondritis. These symptoms may be caused by other, serious health conditions such as heart attack, digestive problems, and cancers that invade the bone. If you experience any one of them, see your physician.
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Sharp, localized anterior chest pain, possibly radiating to the arm or shoulder and possibly aggravated by sneezing, coughing, deep breathing, or twisting motions of the chest
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Tenderness or swelling over a costochondral joint (located on each rib, 1-2 inches on either side of the breast bone)
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. If the diagnosis is in doubt, tests to examine the ribs more closely and to rule out other conditions may include the following:
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Chest x-ray
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Blood tests
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Electrocardiogram (ECG,EKG)–a test that records the heart's activity by measuring electrical currents through the heart muscle to evaluate the heart
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Endoscopy or contrast x-rays of the esophagus and stomach to look for digestive diseases. In endoscopy, a thin, lighted tube is inserted down the throat to examine the digestive system.
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Bone scan to look for cancer in the bones
Treatment
Talk with your doctor about the best treatment plan for you. Once the diagnosis is confirmed and no serious condition is found, treatment is optional. Treatment choices include the following:
Hot or Cold Compresses
Often thermal treatments will provide satisfactory relief until the condition resolves itself.
Over-the-counter Analgesics
Aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Alleve).
Cortisone Injections
An injection of local anesthetic and cortisone directly into the sore joint often relieves the pain.
Intercostal Nerve Block
Very rarely the pain is sufficiently intense and prolonged to require numbing the area with a nerve block.
Prevention
Costochondritis occurs spontaneously at any age, usually without warning or identified causes. There is no way to prevent it.
RESOURCES:
MedlinePlus
http://www.nlm.nih.gov
The Merck Manual of Diagnosis and Therapy
http://www.merck.com
CANADIAN RESOURCES:
BC Heatlh Guide
http://www.bchealthguide.org
Pain Health Info
http://pain.health-info.org
References:
Costochondritis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase Accessed August 9, 2005.
Gilliland BC. Relapsing polychondritis and other arthritides. In: Isselbacher k, et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:1055-1064.
