Costochondritis: A Common Cause for Chest Pain

Introduction

Costochondritis is an inflammation of the costochondral junctions that causes chest pain. These joints help the ribcage protect organs like the heart and lungs. Pain caused by costochondritis mimics aheart attack heart attack or other heart disease, lung disease, osteoarthritis, and gastrointestinal problems. However, costochondritis is a harmless condition that resolves on its own.

What Is Costochondritis?

Costochondritis is the inflammation within the cartilage connecting the rib to the breastbone (sternum). The condition primarily affects the upper ribs on the left-hand side of the body. The inflammation makes breathing or moving the chest painful. The chest pain develops suddenly and progresses slowly across the chest. It is a short-term condition lasting a few days to a few weeks.

Costochondritis is also called chest wall pain syndrome, costosternal, chondrodynia, or costosternal syndrome. It is a common cause of chest pain in children and adolescents. The condition accounts for 10 to 30 percent of chest pain among adolescents. The peak age for developing costochondritis is between 12 to 14 years. Children who carry heavy bags on one shoulder are likely to have costochondritis. Among adults, the condition predominantly occurs in women over 40 years old.

What Is Tietze Syndrome?

When costochondritis accompanies swelling and pain, the condition is called Tietze syndrome. Although Tietze syndrome is called costochondritis, it is a distinct condition. The condition presents as sudden chest pain spreading to the chest and shoulders and lasting several weeks. Tietze syndrome is rare and appears primarily in teenagers or young adults, with equal incidence in males and females.

What Causes Costochondritis?

The exact cause of developing costochondritis remains unclear. However, repeated minor trauma to the chest wall, muscle strain, illness, chest infections, intense physical activity, or severe coughing or vomiting could lead to costochondritis. Other possible causes are overuse of arms, arthritis, tumors, respiratory infections caused by viruses, and bacterial or fungal infections. Costochondritis can also be a sign of arthritis, especially ankylosing spondylitis.

Athletes playing contact sports, Hispanics, or individuals with physically demanding jobs are at higher risk of developing costochondritis.

What Are the Symptoms of Costochondritis?

Chest pain is a common symptom of costochondritis. The pain due to costochondritis develops after exercise, minor trauma, or upper respiratory infections. It occurs on the left side of the breastbone, and the pain may spread to the back or belly. The pain is sharp, aching, or pressure-like, affecting one or more ribs. At times, the pain radiates to the arm and shoulder. Some patients experience worsening pain during deep breaths, coughing, sneezing, vomiting, reaching overhead, exercising, hugging others, lying on the affected side, or during any chest wall movement. The pain improves when the individual stops moving or when breathing is quieter.

Individuals with costochondritis will have tenderness while pressing on rib joints. If costochondritis develops from infection post-surgery, it causes redness, swelling, and pus discharge at the surgery site.

How Is Costochondritis Diagnosed?

The doctors perform physical examinations by feeling along the breastbone to identify tenderness or swelling. The patient's ribs and arms are moved in specific ways to trigger symptoms. The condition cannot be diagnosed or confirmed with laboratory or radiographic imaging. But tests like X-rays and electrocardiograms help rule out other conditions.

What Is the Differential Diagnosis for Costochondritis?

Several conditions present similar to costochondritis and are:

• Acute Coronary Syndrome: The condition is suspected in patients complaining of chest pain. A normal ECG (electrocardiogram) or troponin level helps rule out the condition.

• Pneumothorax: A chest X-ray or Point-of-care ultrasound (POCUS) helps evaluate the possibility of pneumothorax.

• Pneumonia: Individuals complaining of productive cough or fever are at higher risk for pneumonia. A chest X-ray, complete blood count (CBC), and basic metabolic panel help determine pneumonia.

How Is Costochondritis Treated?

Treatment for costochondritis aims at easing pain and waiting for the condition to resolve by itself. Resting the chest and ribcage can help in recovery. The resolution of symptoms takes several weeks or more.

Medications:

• Nonsteroidal Anti-inflammatory Drugs: Ibuprofen or Naproxen are available over the counter to provide pain relief. Prescription medications are available for pain relief, but long-term use causes damage to the kidney and stomach lining.

• Narcotics: Severe pain can be managed with Tramadol. However, the medication can be habit-forming.

• Antidepressant: Amitriptyline is a tricyclic antidepressant used for chronic pain. It is primarily used when the costochondritis pain interferes with sleep. Side effects of taking the medication are drowsiness and weight gain.

• Anti-seizure Medication: Gabapentin is an anti-epileptic medication that is successfully used for managing chronic costochondritis pain.

• Steroids: Doctors may give corticosteroid shots directly into painful joints as a last resort. If the costochondritis pain cannot be controlled by medication or therapy, then numbing medication and corticosteroids are directly injected into the joint.

• Antibiotics: Costochondritis resulting from bacterial and fungal infections are treated with intravenous antibiotics. Later, antibiotics are continued orally or intravenously for two to three weeks.

Therapies

Physical therapy is the best option for treating refractory costochondritis. Therapies for curing costochondritis are:

• Stretching Exercises: Chest muscle can be stretched gently to relieve costochondritis pain.

• Nerve Stimulation: A procedure called transcutaneous electrical nerve stimulation (TENS) contains a device that sends weak electrical signals through patches placed on the skin near areas of pain. The electrical signals interrupt pain signals from reaching the brain.

Surgery

If other treatment fails to alleviate pain, surgical removal of sore cartilage is necessary.

What Home Remedies Help Manage Costochondritis?

Home remedies that provide relief from costochondritis are:

• Taking over-the-counter pain medications can help ease pain caused by costochondritis.

• Local heat or ice application can also help with pain.

• Individuals suffering from costochondritis must avoid unnecessary exercise or activities which worsen the symptoms. The affected individual must avoid contact sports until symptoms improve and should return to normal activities only as tolerated.

• Stretching exercises can help with costochondritis.

Non-infectious costochondritis resolves on its own without needing anti-inflammatory treatment. Most individuals recover completely. However, infectious costochondritis requires intravenous antibiotics and surgery, and recovery takes a long time.

Conclusion

Costochondritis is a common cause of chest pain. Thankfully, it is a harmless condition that resolves by itself. However, the symptoms of costochondritis can be discomforting for affected individuals. The symptoms of pain can be eased with medications or physical therapy. A surgical approach is rarely used for pain relief. Several home remedies may also help relieve pain in individuals affected by costochondritis.