What Is Costochondritis?
Costochondritis (kos-toe-KHON-dri-tis) is a rare condition that results in inflammation of the cartilage connecting a rib to the breastbone (sternum). It causes pain in the costosternal joint, where your ribs and breastbone are joined by rubbery cartilage. This pain can present as sharp, dull, or aching. Pain caused by this condition may mimic that of a heart attack or other heart conditions.
A physician may refer to costochondritis by several different names. These names include chest wall pain, costosternal syndrome and costosternal chondrodynia. When the pain of this condition is accompanied by swelling, it's referred to as Tietze syndrome.
Some cases of costochondritis are caused by surgery or trauma. However, most cases have no apparent cause. In these cases, the focus is directed at treating the pain while the condition improves on its own.
Signs and Symptoms
Costochondritis pain is typically reproducible with tenderness by pressing on the rib joints (costochondral junctions) this is a characteristic feature of this condition. Without reproducible tenderness, a diagnosis is often more difficult.
The most common areas of pain are the fourth, fifth, and sixth ribs (usually on patients left side). This pain may be increased as you move your midsection or take deep breaths. Typically, pain decreases as your movement stops or with quiet breathing.
- Pain will often feel sharp although it may present as dull and gnawing.
- Pain may be present when taking deep breaths, coughing or yawning.
- Exercise may induce pain; deep breathing and joint movement are often causes of pain onset.
- Pain will often radiate to the back, upper abdomen, shoulder, arm, neck and jaw.
Costochondritis can be misdiagnosed or accompanied by anxiety about having chest pain.
When costochondritis occurs as a result of infection after an operation (surgery), there can be inflammation with redness, swelling, or pus discharge at the site of the procedure.
The pain associated with costochondritis is often mistaken for angina, or heart attack pain. The pain of a heart attack is often more widespread, whereas costochondritis pain is usually focused on a more defined area. Heart attack pain usually feels as if it's coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself. Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant.
Don't waste time, though, trying to distinguish between the two if you're experiencing unexplained and persistent chest pain. Chest pain is an emergency - seek medical attention right away.
Doctors don't know what causes most cases of costochondritis. Only some cases have a clear cause. Those causes include:
- Injury. A blow to the chest could cause costochondritis.
- Physical strain. Heavy lifting and strenuous exercise have been linked to costochondritis.
- Upper respiratory illness. An infection that produces sneezing or a cough may produce costochondritis.
- Infection. Infection can develop in the costosternal joint, causing pain.
- Fibromyalgia. Recurring costochondritis could be a symptom of fibromyalgia. People with fibromyalgia often have several tender spots. The upper part of the breastbone is a common tender spot.
- Pain from other areas of your body. Pain signals can sometimes be misinterpreted by your brain, causing pain in places far away from where the problem occurs. Your doctor might refer to this as "referred pain." Pain in your chest can sometimes be caused by problems with the bones in your spine compressing the nerves.
- Auto Immune Disease. Costochondritis is one of many disorders associated with auto immune diseases. Normally it will go away on its own. However, when associated with an auto immune diseases such as PBC, it may linger for years or a lifetime.
How to Prepare for Your Doctor Visit
- Write down all of your symptoms -- include; when they started and how often they occur.
- A list of activities you were performing during or around onset of pain.
- A list of key medical information, include any recent infectious illnesses and other health conditions with which you've been diagnosed. Make a note about any cough or cold you may have had recently. Also list the names of any medications, vitamins or supplements you're taking.
- Note any recent injuries or strenuous exercise that preceded your chest pain.
- Write down key personal information, including any major stressors in your life.
- Bring a friend or family member with you to your appointment. They may be able to help you remember information you may have missed or forgot, which may be very important to receive a diagnosis.
- Create a list of questions to ask your Doctor in advance to help you make the most of your visit.
Tests and Diagnosis
Your doctor will conduct a physical exam to diagnose costochondritis. They will ask you to describe your pain and what triggers it. The pain of this condition can be very similar to the pain associated with heart disease, lung disease, or gastrointestinal problems. Your doctor will feel and press along your breastbone for areas of tenderness and/or swelling.
Typically, costochondritis cannot be seen on chest x-rays or other imaging tests which are used to see inside your body. Subsequently your doctor may orders these tests or others to rule out other conditions or causes for your pain.
Costochondritis typically resolves on its own and is short-lived, although in some cases it may last for several months or even longer.
To ease your pain until it fades, your doctor may recommend:
- NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil) and naproxen (Aleve)
- Your doctor may prescribe antidepressants, more specifically tricyclic antidepressants, if pain is causing difficulty sleeping.
- Muscle relaxants, which can also help ease pain
In cases of autoimmune costochondritis, your doctor may prescribe immunosuppressants.
It is very frustrating to know that there is little your doctor can do to treat costochondritis. But there are ways in which you can make yourself more comfortable while this condition is present. Doing these simple steps can give you a greater sense of control over your condition.
To help relieve the pain of costochondritis, try to:
- Rest. Avoid activities that make your pain worse.
- Exercise. It may seem contradictory to rest, but gentle exercises, such as walking or swimming, can improve your mood and keep your body healthy. Don't overdo it, and stop if exercise increases your pain.
Follow your doctor's suggestions regarding exercise.
- Some people find it useful to apply a heating pad to the painful area several times a day. Keep the heat on a low setting.
- Once your pain is gone, continue taking it easy. Slowly work your way back to your normal activities.
- Meditation is an excellent way to relieve stress and relax your body which will help improve your symptoms.
Costochondritis most often occurs in women and in people over the age of 40. However, this condition may affect anyone in any age category, including infants and children.