What are signs and symptoms of Costochondritis?

Signs and symptoms of costochondritis include: - Pain at the front upper part of the chest. - Pain that worsens with movement, deep breaths, coughing, or stretching. - Sharp or dull pain. - Tenderness when pressing on one or two ribs where they meet the sternum. - Normal vital signs, although a fast heart rate or low blood pressure may suggest another condition as the cause of chest pain. It's important to note that these symptoms can mimic other health issues, so a thorough evaluation is necessary to rule out conditions such as heart disease, blood clots in the lungs, tear in the aorta, pneumonia, injuries to the esophagus, collapsed lung, or physical injuries.

What else can Costochondritis be?

The doctor needs to rule out the following conditions when diagnosing Costochondritis: - Heart-related conditions like angina or heart attack - Pericarditis - Pneumothorax - Pneumonia - Aortic dissection - Pulmonary embolism - Esophageal perforation and gastroesophageal reflux disease - Various types of arthritis and infections - Painful xiphoid syndrome - Herpes zoster (shingles) - Slipping rib syndrome and Tietze's syndrome - Muscle pain from trauma or overuse - Fibromyalgia - Ankylosing spondylitis and psoriatic arthritis - SAPHO syndrome and lupus - Panic disorder

What kinds of test are needed for Costochondritis?

The types of tests that may be ordered to properly diagnose costochondritis include: - Chest x-ray: This can help identify conditions like pneumonia, spontaneous lung collapse, or any unusual growths in the lungs. - Ultrasound: This can detect any fractures and rule out other serious conditions that could present similar symptoms. - Electrocardiogram (ECG): This is recommended for adults with anterior chest pain to check for any heart abnormalities, although it would generally appear normal if you have costochondritis.

How is Costochondritis treated?

Costochondritis is typically treated by focusing on easing the symptoms. This can be done through the application of heat and topical medications such as capsaicin, diclofenac gel, and lidocaine patches. Over-the-counter pain relievers like NSAIDs or acetaminophen may also be useful. In cases where the pain persists despite these treatments, a program of stretching exercises provided by a physical therapist may be helpful. Local corticosteroid injections and acupuncture are options that can be considered if more traditional treatments do not work, although the evidence for their effectiveness is limited.

Costochondritis

What is Costochondritis?

Costochondritis, also known as costosternal or anterior chest wall syndrome, refers to the inflammation of the cartilages that connect the rib bones to the breastbone. This non-serious condition manifests as localized chest pain that gets worse with movement or pressing, often resembling more serious conditions like heart problems. Diagnosis is based on clinical evaluation and ruling out serious causes. The treatment typically involves pain-relieving medications and physical therapy. Even though the condition is not harmful, teamwork among health professionals is important to ensure an overall high standard of patient care and improved results.

The chest wall is made up of the ribs, the costal cartilages, and the sternum, which are designed to protect the organs in the chest and allow for breathing movements. Out of the 12 pairs of ribs, the first 7 are known as true ribs because they connect directly to the sternum through their costal cartilages. The next three pairs, 8 to 10, are classified as false ribs, they attach indirectly to the sternum through their cartilage connections to the ribs above them. The 11th and 12th pairs are called “floating ribs,” as they don’t attach to the sternum at all. The sternum, or breastbone, is a flat bone located at the center of the chest, and consists of the manubrium, body, and xiphoid process.

In costochondritis, the junctions where the costal cartilages join with the sternum, also known as costochondral junctions, are key. They are made of a type of cartilage called hyaline cartilage, which can become inflamed, causing the condition.

What Causes Costochondritis?

Costochondritis is a condition that is caused by the inflammation of the costochondral joint, which results in pain. Often, the exact cause of this condition is unknown. However, some potential triggers for costochondritis could be infections, repeated injuries, certain types of arthritis, chest tumors, use of intravenous drugs, and rheumatologic disorders.

Risk Factors and Frequency for Costochondritis

Costochondritis, a type of chest pain, is estimated to affect between 4% and 50% of people who experience chest pain at some point in their lives. The exact percentage of people affected by it is unknown. A study in 1994 found that women are more likely to experience costochondritis. An analysis of chest pain cases in the emergency department found costochondritis in some patients who didn’t have cancer, a fever, or injuries. Some other studies have shown that a significant percentage of non-heart-related chest pains have a musculoskeletal cause, like costochondritis.

Costochondritis was diagnosed in 30% of specific emergency department cases.
In a study, 45% of 1,300 emergency room visits for chest pain were due to musculoskeletal causes.
In a larger study of 15,000 emergency room visits, 16% of the patients had musculoskeletal chest pain.
In walk-in clinics, between 33% and 47% of patients with chest pain had a musculoskeletal cause.

Costochondritis generally affects adults who are between 40 and 50 years old. This can be tricky because the chest pain can sometimes be confused with heart-related issues. In teenagers visiting an outpatient clinic, about 31% of chest pain cases are due to musculoskeletal causes, like costochondritis, which makes up 13% of these cases.

Signs and Symptoms of Costochondritis

Costochondritis is a condition where people usually experience pain at the front upper part of their chest. This pain can get worse when they move, take deep breaths, cough, or stretch. The pain might feel sharp or dull.

In addressing this condition, it’s important to get a clear understanding of the patient’s history and symptoms. This includes their medical history, lifestyle, family history, and an overall check on their health. This information can help rule out other health issues that can mimic costochondritis like heart disease, blood clots in the lungs, tear in the aorta, pneumonia, injuries to the esophagus, collapsed lung, or any physical injuries. It’s equally vital to know what makes the pain worse or better.

A physical exam should focus on the chest area including the heart, lungs, neck, skin, and chest wall. The skin will be checked for any abnormalities such as rashes and swelling that might point to a different health issue, like shingles. The sternum (breastbone) and the joints connecting the sternum and collarbone will also be examined for signs of warmth, swelling, or redness which are not typical signs of costochondritis and might suggest a different condition.

Chest pain due to costochondritis can be recreated by pressing gently to moderately on the upper areas where the ribs join the sternum. Usually, pressing on one or two ribs where they meet the sternum will often cause tenderness. But it’s crucial to know that chest pain due to heart disease can sometimes feel the same.

Other methods to bring about the symptoms of costochondritis include the “crowing rooster” and “horizontal arm flexion.” The “crowing rooster” requires the patient to extend their neck upwards while sitting, and then the doctor gently pulls their upper arms backward and up. Horizontal arm flexion is done by having the patient move an arm towards the chest while turning their head towards the same side. The doctor then applies a steady, prolonged pull. The same procedure is done with the other arm.

Patients with costochondritis usually have normal vital signs. A fast heart rate or low blood pressure may suggest that another condition could be the cause of the patient’s chest pain.

Testing for Costochondritis

When you have chest pain, your doctor may want to rule out other serious conditions like a heart attack or pneumonia. To do this, they’ll recommend different tests based on your age, symptoms, and risk factors. For instance, The American College of Rheumatology suggests having a chest x-ray taken. This can help identify conditions like pneumonia, spontaneous lung collapse, or any unusual growths in the lungs.

Moreover, your doctor may use an ultrasound, which can detect any fractures. While they normally don’t use imaging to diagnose costochondritis (chest wall pain due to inflammation), they might use it to rule out other serious conditions that could present similar symptoms. It’s also usually recommended for adults with anterior chest pain to have an electrocardiogram (ECG) done to check for any heart abnormalities. However, keep in mind that both chest x-rays and ECGs would generally appear normal if you have costochondritis.

Treatment Options for Costochondritis

Costochondritis is a non-serious condition that goes away on its own. Treatment mostly focuses on easing the symptoms. Applying heat and topical medications like capsaicin, diclofenac gel, and lidocaine patches can help. Also, over-the-counter pain relievers like NSAIDs or acetaminophen may be useful.

One small study found that a program of stretching exercises provided by a physical therapist can help patients whose pain doesn’t go away with other treatments. Using local corticosteroid injections directly into the area where the rib and cartilage connect isn’t backed by enough evidence, so it’s usually only tried if more traditional treatments don’t work. There’s not a lot of strong research on the effectiveness of acupuncture for this condition, but a small study showed it might help improve long-lasting chronic pain.

When trying to pinpoint the cause of chest pain, doctors typically consider three types of possible sources: conditions inside the chest, conditions affecting the chest wall, and systemic disorders that can lead to chest pain.

Conditions inside the chest that could be causing the pain include:

Heart-related conditions like angina or heart attack, which may be suspected in older patients or those with a family history of heart disease, high blood pressure, diabetes, or unhealthy habits such as smoking.
Pericarditis, a condition that involves inflammation of the protective sac around the heart. It’s typically characterized by chest pain that changes with body position and could be linked to recent viral illnesses or certain autoimmune diseases.
Pneumothorax, which is a collapsed lung. This might be suspected in someone with sudden onset chest pain and shortness of breath, especially if they’ve had prior episodes or an underlying lung condition.
Pneumonia, which often involves chest pain, difficulty breathing, coughing and fever, and primarily affects older individuals or those with compromised immune systems.
Aortic dissection, which may cause chest pain that spreads to the arm or back and could be associated with high blood pressure and heart disease.
Pulmonary embolism, a blood clot in the lungs, which could cause chest pain and difficulty breathing. This condition may be suspected in someone with risk factors such as a history of cancer, recent travel or surgery, smoking, or contraceptive use.
Esophageal perforation and gastroesophageal reflux disease, which often present with severe or worsening chest pain potentially related to recent endoscopies, persistent vomiting, alcohol dependence, lung cancer, and certain eating or sleeping patterns.

Regarding conditions of the chest wall that might cause pain:

Various types of arthritis and infections can produce localized pain, swelling, and redness.
Painful xiphoid syndrome is identified by localized discomfort when the xiphoid process, a small cartilage structure at the base of the sternum, is palpated.
Herpes zoster (shingles) may cause severe, neuropathic pain accompanying a rash in a specific pattern on the body.
Several other conditions such as slipping rib syndrome and Tietze’s syndrome can lead to localized chest or abdominal pain and swelling in the rib area.
Muscle pain from trauma or overuse due to sports or occupational activities could also cause chest wall pain.

Lastly, systemic disorders that might cause chest pain include:

Fibromyalgia, which is often characterized by long-standing, widespread pain, fatigue, insomnia, and mood issues.
Ankylosing spondylitis and psoriatic arthritis, which can cause pain and inflammation in the chest and spine, and are often characterized by other symptoms like stiffness, limited mobility, joint swelling, and skin changes.
SAPHO syndrome and lupus, which can present as chest pain, arthritis, skin changes, and other symptoms.
Panic disorder, which might cause chest pain among other physical symptoms during an episode of panic or anxiety.

Accurate diagnosis requires a careful clinical evaluation and appropriate testing to ensure life-threatening conditions are ruled out before treatment begins.

What to expect with Costochondritis

Costochondritis is a condition that typically resolves on its own. Over 90% of individuals notice a significant improvement in their symptoms within 3 to 4 weeks.

Possible Complications When Diagnosed with Costochondritis

Costochondritis is a condition that typically goes away on its own. However, a small number of patients might have costochondritis that doesn’t improve or keeps coming back. These patients may need to see a rheumatology specialist. The specialist can look for causes of chest pain that affect the whole body and may consider minimally invasive treatments like injections of anti-inflammatory steroids.

Preventing Costochondritis

To prevent costochondritis, or inflammation of the chest wall, you need to make lifestyle changes that reduce strain on the chest. This includes making sure to keep a good posture and avoiding actions that put extra stress on your chest, like heavy lifting or repeating certain movements too many times. Managing stress and regularly doing light exercises that strengthen your chest muscles, without causing too much strain, can help manage symptoms and reduce the chance of experiencing this condition multiple times. Treating health conditions that may lead to costochondritis, such as certain rheumatological disorders or respiratory infections, could also be a preventive measure.

For those who have already experienced costochondritis, knowing what can make the pain worse can help manage the condition. Activities like sneezing, coughing, and overusing the chest muscles can increase the pain. It’s important to understand that this condition is not harmful and often gets better on its own. Following your doctor’s instructions for treatment is key to recovery. If you experience worsening chest pain, difficulty breathing, dizziness, fainting, or visible issues on your chest, like swelling or a rash, make sure to return for more medical help.