Costochondritis

Description

Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.

Costochondritis is sometimes known as chest wall pain syndrome, costosternal syndrome or costosternal chondrodynia. Sometimes, swelling accompanies the pain (Tietze's syndrome).

What causes costochondritis is clear. The treatment is focused on relieving the pain while waiting for the condition to improve on their own, which can take several weeks or more.

Symptoms

The pain associated with costochondritis usually:

  • Occurs on the left side of the sternum
  • It is acute, the pain or pressure, as
  • Affects more than one rib
  • May radiate to the arms and the shoulders
  • It gets worse when taking a deep breath, the coughing, sneezing, or with any movement of the chest wall

When to see a doctor

For chest pain, seek emergency medical attention to rule out life-threatening causes, such as a heart attack.

Causes

Costochondritis usually has no clear cause. However, costochondritis can be associated with trauma, illness or physical exertion, such as a severe cough.

Risk factors

Costochondritis occurs more often in women older than 40 years.

The Tietze's syndrome usually presents in adolescents and young adults, and with equal frequency in men and women.

Costochondritis

Diagnosis

During the physical exam, a health care provider that is felt along his breastbone to the tenderness or swelling. The provider can also move the rib cage or your arms in certain ways to try to trigger the symptoms.

The pain of costochondritis may be similar to the pain associated with heart disease, lung disease, gastrointestinal problems, and osteoarthritis. There is no laboratory or imaging test to confirm the diagnosis of costochondritis. But a doctor may order certain lab tests, such as an electrocardiogram and chest x-rays to rule out other conditions.

Treatment

Costochondritis usually goes away on its own, but may last for several weeks or longer. The treatment is focused on relieving the pain.

Drugs

Your health care provider may recommend:

  • Nonsteroidal anti-inflammatory drugs. You can buy some of these types of drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), over-the-counter. Stronger versions are available by prescription. The side effects can include damage to the mucosa of the stomach and kidneys.
  • Narcotics. If the pain is severe, a doctor may prescribe a narcotic medication such as tramadol (Ultram). Narcotics can be habit-forming.
  • Antidepressants. Tricyclic antidepressants, such as amitriptyline, are often used to manage chronic pain, especially if the pain interferes with sleep.
  • Anti-seizure drugs. The epilepsy drug gabapentin (Gralise, Neurontin) has also proven to be a success in the control of chronic pain.

Therapies

Physical therapy treatments may include:

  • Stretching exercises. Gentle stretching exercises for the muscles of the chest may be helpful.
  • The stimulation of the nerve. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current through sticky patches on the skin near the area of pain. The current could interrupt or mask pain signals, which prevents them from reaching the brain.

Surgery or other procedures

If conservative measures don't work, another option is the injection of a medicine and a corticosteroid directly into the painful joint.

Self-care

It can be frustrating to know that there is little that can be done to treat costochondritis. But the self-care measures, such as the following, might be of assistance.

  • Non-prescription pain relievers. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be useful.
  • Topical pain relievers. These include creams, gels, patches and sprays. May contain nonsteroidal anti-inflammatory drugs or numbing medications. Some varieties contain capsaicin, the substance that makes peppers spicy.
  • Heat or ice. Try placing hot compresses or a heating pad on the affected area several times a day. Keep the heat on a low setting. The ice can also be helpful.
  • Rest. Avoid or modify the activities that may worsen the pain.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the joints (rheumatologist).

What you can do

Ask a relative or friend to accompany you, to help you remember what your provider tells you.

Make a list of:

  • The symptoms, including any that may seem unrelated to the reason for the appointment, and when they began
  • Key medical information, including other conditions, and any type of joint injury that hurts
  • Key personal information, including major life changes or stressors
  • All the medications, vitamins and supplements, including doses
  • Questions for the health care provider

Questions to ask your doctor

  • What is the most likely cause of my symptoms?
  • What tests do I need?
  • What self-care steps can help?
  • What do I need to restrict the activities?
  • What new signs or symptoms should I watch for?
  • When can I expect my symptoms to resolve?
  • I have other health conditions. How can I best manage them together?

Do not hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask a series of questions, including:

  • The symptoms worsened over time?
  • Where is the pain?
  • Exercise or physical effort to make your symptoms worse?
  • What else to do, that their pain is worse or better?
  • Are you having difficulty breathing?
  • Have you had in the past respiratory infections or injuries to the chest?
  • Are you aware of a history of heart problems in your family?
Symptoms and treatment of Costochondritis