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Costochondritis is an inflammation of the cartilage that joins a rib to the breastbone (sternum), forming the costochondral joint. It is a common cause of chest pain which can be sometimes mistaken as a heart attack. It causes an acute or agonizing pain in the chest area.
The pain can come on quickly or gradually and extend throughout the chest. Although commonly misinterpreted as a heart attack, costochondritis is not life-threatening. Costochondritis is also known as chest wall discomfort syndrome, costosternal syndrome, or costosternal chondrodynia. The inflammation may accompany pain at times, known as Tietze syndrome.
The underlying cause of costochondritis is not yet fully understood. While the symptoms may subside on their own, it can take several weeks. Treatments are available to alleviate discomfort and aid in the recovery process. It is crucial to obtain a prompt and accurate diagnosis, as chest pain can sometimes indicate serious medical conditions.
Symptoms
Costochondritis is characterized by chest pain, which can develop gradually over time or occur suddenly. Specifically, one may feel:
- Pain that starts on the left side of the chest and spreads out to the rest of the chest, stomach or back
- Pain that affects more than one rib
- Pressure-like, aching or sharp pain
- Pain intensifies when hugging, lying down, breathing deep, sneezing, coughing or being physically active
If you experience chest pain, it is essential to seek immediate medical attention to rule out potentially life-threatening causes such as a heart attack. Proper diagnosis is crucial for receiving the appropriate treatment.
Causes
While the exact cause of costochondritis is unknown, experts suggest that it may be triggered by:
- Trauma or injury in the chest
- Physical strain such as coughing too hard
- Respiratory tract infection
- Frequent use of arms
- Exercising too much
- Bacterial or fungal infection
It may also occur due to an underlying illness affecting the cartilage such as osteoarthritis, ankylosing spondylitis, or rheumatoid arthritis.
Risk factors
Costochondritis is a prevalent diagnosis in patients suffering from chest pain. According to one study, 30% of those who go to the emergency room with chest pain had costochondritis.
Statistically, it is often diagnosed in adults, particularly women older than 40. It contributes for 10% to 30% of chest discomfort complaints in adolescents aged 12 to 14.
Tietze syndrome affects both males and females equally and is most commonly seen in adolescence and young adults.
Diagnosis
Costochondritis is typically diagnosed by a process of elimination based on symptoms and physical examination. While there is no specific laboratory or imaging test to confirm the diagnosis, a healthcare provider may order tests such as an electrocardiogram or chest X-ray to rule out other conditions that may present with similar symptoms.
Costochondritis pain might be similar to pain from heart disease, lung disease, digestive issues, and musculoskeletal issues. To confirm the diagnosis, the doctor will need to feel around the breastbone for soreness or inflammation during the physical exam. The doctor may also move the rib cage or arms in specific ways to try to elicit symptoms.
In some cases, the doctor may inquire about the mental/emotional health of a person, since stress, worry, and panic attacks can induce chest pain.
Treatment
Costochondritis often resolves on its own, but in some cases, treatment may be needed to manage the symptoms. The goal of treatment is usually to relieve pain and swelling while waiting for the condition to resolve. Depending on the severity of the symptoms and how long they last, a doctor may prescribe medications.
- Medications: The following drugs may be advised:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications may be recommended to manage the pain associated with costochondritis such as ibuprofen, naproxen sodium, or acetaminophen. Prescriptions are required for stronger forms. Damage to the stomach lining and kidneys are potential side effects.
- Narcotics: This is often prescribed with caution as it can become addictive. It is only given if the pain becomes severe. Tramadol is the commonly prescribed narcotics for costochondritis.
- Antidepressants: These are frequently used to treat chronic pain, particularly when it affects one’s sleep. Tricyclic antidepressants, such as amitriptyline are usually prescribed.
- Anti-seizure drugs: Gabapentin may be recommended for managing intense pain. This drug is often used as an epilepsy medication.
- Therapies: Physical therapy treatments might include:
- Stretching exercises. Light chest muscle stretching exercises may be beneficial to help with the pain.
- Nerve stimulation. Transcutaneous electrical nerve stimulation (TENS) is used to relieve both acute and chronic pain. TENS is a small device that sends low-voltage electrical impulses to the surface of the skin via electrodes. The electrodes are placed on or near nerves that cause pain or at trigger points.
Theoretically, the electric current activates nerve cells, which impede the passage of pain signals, so altering the feeling of pain. Or it increases the level of endorphins, the body’s natural painkiller, which then prevent the sense of pain.
- Other procedures: Corticosteroids, an anti-inflammatory drug, may be given locally through joint injections if none of the other treatment methods work. This may be administered together with a numbing medication. Steroids is known to decrease inflammation and provide significant relief from pain.
