Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal
chondrodynia is an acute and often temporary inflammation of the costal cartilage, the
structure which connects each rib to the sternum at the costosternal joint.
The condition is a common cause of chest pain.
Though costochondritis often resolves on its own, it can be a recurring condition that
can appear to have little or no signs of onset.
Treatment options are quite limited and usually involve a combination of rest, analgesics,
or anti-inflammatory medications.
Cases with intractable discomfort may be managed with cortisone injections or surgery may be
indicated if the condition is severe.
Individuals with costochondritis are typically instructed to avoid strenuous physical activity
to prevent the onset of an attack.
Costochondritis symptoms can be similar to the chest pain associated with a heart attack.
Unexplained chest pain is considered a medical emergency until life-threatening cardiac issues
can be ruled out.
Severe cases of costal cartilage inflammation that also involve painful swelling are sometimes
referred to as Tietze's syndrome, a term sometimes used interchangeably with costochondritis.
However, some physicians view costochondritis and Tietze's syndrome as separate disease
states due to the absence of costal cartilage swelling in costochondritis.
Signs and symptoms Pain or tenderness to palpation usually occurs
on the sides of the sternum, affects multiple ribs, and is often worsened with coughing,
deep breathing, or physical activity.
On physical examination, physicians will inspect and palpate the patient for areas of swelling
or tenderness and can often reproduce the pain associated with costochondritis by moving
the patient's rib cage or arms.
A factor that may aid in the differentiation of costochondritis from Tietze's syndrome
is the location of the pain on the sternum.
Costochondritis typically affects the third, fourth, and fifth costosternal joints in contrast
to Tietze's syndrome, which usually affects the second or third costosternal joint.
Pain from costochondritis typically resolves within one year.
Causes In most cases of costochondritis, no cause
is identified.
However, costochondritis may be the result of physical trauma, associated with scoliosis,
ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, or a tumor.
Infection of the costosternal joint may cause costochondritis in rare cases.
Most cases of infectious costochondritis are caused by Actinomyces, Staphylococcus aureus,
Candida albicans, and Salmonella.
In rare cases, Escherichia coli can be a cause of infectious costochondritis.
Pathogenesis The pathogenesis underlying the development
of costochondritis remains unclear.
Proposed mechanisms of injury include neurogenic inflammation, muscular imbalance, increased
muscular pull on the rib, mechanical dysfunction at the costotransverse joint of the rib, or
a derangement of the mechanical structure of the costochondral junction.
Differential diagnosis
Other causes of chest pain similar to that produced by costochondritis may include, but
are not limited to the following: Cardiac:
Heart Attack Pericarditis/myocarditis
Aortic aneurysm
Gastrointestinal:Gastroesophageal reflux disease Gastritis
Esophagitis
Musculoskeletal: Fibromyalgia
Rib fracture Ankylosing spondylitis
Bone metastasis from cancers such as prostate cancer, breast cancer, plasmacytoma, and sarcomas
Reactive arthritis
Psychogenic: Anxiety disorder
Panic disorder Hyperventilation
Respiratory: Pneumonia
Pneumothorax Pleuritis
Pulmonary embolism
Other: Herpes zoster
Drug abuse Multiple Myeloma
Treatment Costochondritis may be treated with physical
therapy or with medication.
Treatment may involve the use of nonsteroidal anti-inflammatory drugs such as ibuprofen
or other pain relief medications such as acetaminophen.
Severe cases of costochondritis may call for the use of opioid medications such as hydrocodone
or oxycodone, tricyclic antidepressant medications such as amitriptyline for pain from chronic
costochondritis, or anti-epileptic drugs such as gabapentin may be used.
Oral or injected corticosteroids may be used for cases of costochondritis unresponsive
to treatment by NSAIDS; however, this treatment has not been the subject of study by rigorous
randomized controlled trials and its practice is currently based on clinical experience.
Rest from stressful physical activity is often advised during the recovery period.
Epidemiology Costochondritis is a common condition and
is responsible for 30% of emergency room chest pain related visits.
One-fifth of visits to the primary care physician are for musculoskeletal chest pain, of this
20% of primary care office visits, 13% is due to costochondritis.
Costochondritis cases are most often seen in people older than age 40 and occurs more
often in women.
See also Costochondral cartilage
References
External links MayoClinic.com
Benign Tender Chest Wall Pain of Costosternal Joints Inflammation at patient.co.uk
Costochondritis and Tietze Syndrome