Costochondritis

Costochondritis refers to an inflammation of the flexible fibrous connective tissue, or cartilage that links upper ribs to the breastbone (sternum).

If inflammation is accompanied by pain, it is called Tietze’s syndrome. The pain feels like a heart attack or similar heart conditions.

Also called chest wall pain, costosternal syndrome, or costosternal chondrodynia, the condition may not have any obvious cause.

Costochondritis is a relatively harmless musculoskeletal chest pain. It mainly affects women compared to men. Out of all who are affected, around 70% are women.

The mild chest pains due to this condition may only cause the chest to feel tender to touch or slight pain when one pushes or touches on the area of chest cartilage.

Severe chest pain can cause shooting pain that spreads down to the limbs or unbearable chest pain that interferes with daily activities without seeming to go away.

The signs of the condition often resolve after several weeks and treatment involves pain management. The main objective of treatment is to provide relief from the pain as the person waits for the condition to improve.

A complete cure may take weeks and in the process the treatment will be focused on pain management.

A sharp pain, often like a heart attack, on your left side is the main symptom of costochondritis. The pain can occur in more than one rib and becomes intense while coughing or taking deep breath.

The pain linked to costochondritis normally:

• Occurs on the left side of the breast bone
• Is a sharp or aching pain
• Radiates to the back or abdomen
• Affects more than one rib
• Affects the upper or middle rib
• Worsens while taking deep breaths, moving, stretching, or coughing

The other signs and symptoms of costocondritis include:

• A reproducible tenderness felt while pressing on the rib joints
• Previously incorrect diagnosis or accompanied by apprehension about having chest pain

When costochondritis occurs due to an infection after surgery, there will be inflammation along with redness or pus discharge at the location of the procedure.

When to see a doctor

Immediately seek emergency medical care if you experience chest pain, to exclude other serious cause like heart attack.

You should consult a doctor if you are experiencing any of the below symptoms:

• Difficulty breathing
• High fever
• Signs of infection like redness, pus formation, or increase in the swelling at the rib joints
• Persistent or worsening pain even after taking over-the-counter anti-inflammatory medication

Often, the cause of costochondritis is not evident.

In some cases, it may occur due to:

• Injury or trauma to the chest: For instance a blunt force against the chest wall or a huge impact from a car accident
• Physical strain: Activities like heavy lifting, high intensity exercise, and severe coughing can be some of the factors that can cause costochondritis
• Arthritis: Costochondritis can be linked to the following problems - Osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis
• Joint infection: Infections of the joint caused by virus, bacteria, and fungi (for example, tuberculosis, syphilis and aspergillosis)
• Tumors: Cancer might spread to the joint from distant body parts such as the breast, thyroid, or lung. Both noncancerous and cancerous tumors can cause costochondritis
• Viral: Specific viruses or respiratory conditions like uberculosis and syphilis can lead to joint inflammation
• Bacterial: Costochondritis can occur after a surgery, due to a bacterial infection
• Fungal: Even though rare, fungal infections can also costochondritis

Diagnosis of costochondritis begins with physical examination of the breastbone. It involves feeling the breastbone to find out where the pain and swelling has occurred and to see if any activity can trigger the pain. The doctor will move the rib cage or arms of the patient in different ways to trigger the symptoms. The doctor will also look for signs of infection or inflammation such as redness, swelling, and pus formation.

Costochondritis pain resembles that of heart disease, lung disease, gastrointestinal problems, and osteoarthritis. There is no specific laboratory or imaging test to confirm the diagnosis of costochondritis. The doctor might still suggest the patient to undergo certain tests like electrocardiograph, X-ray, blood test, CT, or MRI, to rule out the possibility of other serious conditions.

• A sophisticated imaging test of the chest, known as the gallium scan, can be done to check for any infection
• In cases of infection, the white blood cell count will be high
• Chest X-ray is recommended if the doctor suspects pneumonia as the cause of chest pain
• The doctor will suggest ECG and other tests if they consider the chest pain to be linked with a heart problem

How to prepare yourself for the visit

Being fully educated for your visit will make it more effective. 

Be sure to:

• List out all the symptoms
• Write down your key medical information. Mention if you have a history of injury to the affected part
• Write down the names of all your medications, vitamins, or supplements
• Make a list of questions to ask your doctor

Some sample questions can be:

• What could be causing my symptoms?
• What kinds of tests do you recommend?
• What self-care steps are likely to help improve my symptoms?
• What are the other signs and symptoms I should watch out for?
• Do I need to restrict any activities?
• How long will it take to recover?
• Are any lifestyle changes required?

What your doctor wants to know

A clear talk with your doctor can optimize treatment and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you a lot of questions as this will help in analyzing the situation and diagnosing the cause of the problem.

Your doctor may ask:

• When did your symptoms appear?
• How severe are the symptoms?
• Where is your pain located?
• Does exercise or physical exertion make your symptoms worse?
• Does anything else seem to make your pain worse or better?
• Do you have difficulty breathing?
• Any recent history of respiratory infections or injury to your chest?
• Have you been recently diagnosed with any other medical condition?
• Have you recently experienced severe stress or a drastic change?
• Do you have a family history of heart problems?

No laboratory or imaging test can confirm costochondritis, but you may be recommended tests like electrocardiograph, X-ray, CT or MRI to exclude other likely conditions.

The signs of costochondritis often resolve after several weeks and treatment involves pain and symptom management.

Medications

• Pain relievers: You may use pain relievers, such as over-the-counter ibuprofen or naproxen or higher doses of nonsteroidal anti-inflammatory medications under prescription. You may experience common side effects like abdominal discomfort and heartburn.
• Narcotics: In case your pain is severe, consult your doctor if codeine-containing formulations such as hydrocodone/acetaminophen or oxycodone/acetaminophen can help. Remember that these drugs can cause addiction.
• Antidepressants: Chronic pain is often managed by depression-treating drugs like amitriptyline.
• Anti-seizure drugs: The epilepsy drug gabapentin is found to be effective in controlling chronic pain.

Therapy

• Physical: You can expect to find relief from stretching exercises for the chest muscles.
• Nerve stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) uses weak electrical current to interfere the transmission of pain signals, preventing them from reaching your brain. The current producing device is placed near the painful areas.
• Surgical and other procedures: This invasive treatment is the ultimate option if the pain does not respond to other measures. Your doctor injects numbing medication and a corticosteroid directly into the painful joint.

There are different ways to adapt your lifestyle in coping with costochondritis.

Pain in itself is a major cause of distress, and frustration can develop when you realize there is little you can do that can control it.

The following tips may help you cope better with the pain:

• Pain relievers: Over-the-counter (OTC) drugs such as ibuprofen or naproxen may provide some degree of relief.
• Heat or ice: Exposure to hot or cold temperature can sometimes lower the pain. Try some hot compress or ice packs over the affected areas.
• Rest: Hold back from activities that may worsen your pain.

There are several risks associated with costochondritis. Women and people over 40 are more likely to have costochondritis, while Tietze’s syndrome is equally probable in both men and women, and usually occurs in teenagers and young adults.

Prolonged pain that is caused by costochondritis can be unbearable if left untreated. Usually, the treatment of the inflammation and pain causes this condition to eventually fade away on its own.

But if a person has chronic costochondritis, the pain may reoccur even during and after treatment. The pain will reoccur when the person does any exercise or engages in certain activities. In such a scenario, the person will have to opt for long term treatment and care to ensure that costochondritis does not affect their routine activities and the quality of their life.

Chest pain which is associated with costochondritis can also indicate other health problems. Chest pain can often mean that the person is suffering from some heart problems or other medical conditions. Therefore, it is necessary for a person to immediately consult the doctor if he/she is experiencing chest pain to confirm that it is not due to heart attack, pneumonia, etc.

Chest pain from costochondritis is a common symptom of fibromyalgia.

In fibromyalgia, one may experience soreness in the chest along with the following symptoms:

• Pain throughout the body
• Fatigue
• Inability to rest due to pain
• Unable to focus or concentrate on things
• Depression
• Headaches

If a person experiences the above mentioned symptoms along with chest pain, the doctor might suggest testing for fibromyalgia. It is essential to understand these conditions and the symptoms as this will help in performing treatment on time and ensuring that these medical conditions do not affect daily activities.

What is the long-term outlook for costochondritis?

Costochondritis is not a persistent condition and typically goes away with time, medication, and adequate rest. Mild cases of costochondritis will disappear after a couple of days without any treatment. Chronic cases will last for weeks or months, but most cases do not prolong more than a year.

In order to avoid the chances of persistent and chronic costochondritis, preventive measures are important.

Keep these in mind:

• Carry and lift heavy loads properly
• Be mindful of high impact exercises or manual labor

Call the doctor immediately if you experience chest pain while doing any of the above mentioned activities.

Here are some other preventive tips to keep in mind:

• Avoid repeated trauma or injury to the costochondral junctions
• Treat infections promptly
• If you are in physical therapy, follow your physician's instructions carefully
• Sleep in a comfortable position
• Make sure any bags you carry daily are not heavy