Costochondritis

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.