Costochondritis Overview

Costochondritis is an inflammation of the junctions where the upper ribs join with the
cartilage that holds them to the breastbone or sternum. The condition causes localized
chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage.
Costochondritis is a relatively harmless condition and usually goes away without
treatment. The cause is usually unknown.

• Costochondritis (with unknown cause) is a common cause of chest pain in

children and adolescents. It accounts for 10-30% of all chest pain in children.
Annually, doctors evaluate about 650,000 cases of chest pain in young people 10-
21 years of age. The peak age for the condition is 12-14 years.

• Costochondritis is also considered as a possible diagnosis for adults who have

chest pain. Chest pain in adults is considered a potentially serious sign of a heart
problem by most doctors until proven otherwise. Chest pain in adults usually
leads to a battery of tests to rule out heart disease. If those tests are normal and
your physical exam is consistent with costochondritis, your doctor will diagnose
costochondritis as the cause of your chest pain. It is important, however, for adults
with chest pain to be examined and tested for heart disease before being
diagnosed with costochondritis. Often it is difficult to distinguish between the two
without further testing. The condition affects females more than males (70%
versus 30%). Costochondritis may also occur as the result of an infection or as a
complication of surgery on your sternum.

• Tietze syndrome is often referred to as costochondritis, but the two are distinct
conditions. You can tell the difference by noting the following:

o Tietze syndrome usually comes on abruptly, with chest pain radiating to

your arms or shoulder and lasting several weeks. Tietze syndrome is
accompanied by a localized swelling at the painful area (the junction of
the ribs and breastbone).

Costochondritis Causes

Costochondritis is an inflammatory process but usually has no definite cause. Repeated

minor trauma to the chest wall or viral respiratory infections can commonly cause chest
pain due to costochondritis. Occasionally, costochondritis as a result of bacterial
infections can occur in people who use IV drugs or who have had surgery to their upper
chest. After surgery, the cartilage can become more prone to infection, because of
reduced blood flow in the region that has been operated on.

Different types of infectious diseases can cause costochondritis.

 • Viral: Costochondritis commonly occurs with viral respiratory infections because
of the inflammation of costochondral junctions from the viral infection itself, or
from straining from coughing.

• Bacterial: Costochondritis may occur after surgery and be caused by bacterial

infections.

• Fungal: Fungal infections are rare causes of costochondritis.

Costochondritis Symptoms

• Chest pain associated with costochondritis is usually preceded by exercise, minor

trauma, or an upper respiratory infection.

• The pain usually will be sharp and located on your front chest wall. It may radiate
to your back or abdomen and is more common on your left side.

• The most common sites of pain are your fourth, fifth, and sixth ribs. This pain
increases as you move your trunk or take deep breaths. Conversely, it decreases as
your movement stops or with quiet breathing.

• The reproducible tenderness you feel when you press on the rib joints
(costochondral junctions) is a constant feature of costochondritis. Without this
tenderness, a diagnosis of costochondritis is unlikely.

o Tietze syndrome, on the other hand, exhibits swellings at the rib-cartilage

junction. Costochondritis has no noticeable swelling. Neither condition
involves pus or abscess formation.

o Tietze syndrome usually affects the junctions at the second and third ribs.
The swelling may last for several months. The syndrome can develop as a
complication of surgery on your sternum months to years after the
operation.

o When costochondritis occurs as a result of infection after surgery, you will

see redness, swelling, or pus discharge at the site of the surgery.

When to Seek Medical Care

Call the doctor for any of the following symptoms:

• Trouble breathing

• High fever
 • Signs of infection such as redness, pus, and increased swelling at the rib joints

• Continuing or worsening pain despite medication

Go to a hospital's emergency department if you have difficulty breathing or any of the

following symptoms occur. These symptoms are generally not associated with
costochondritis:

• High fever not responding to fever-reducers such as acetaminophen (Tylenol) or

ibuprofen (Advil)

• Signs of infection at the tender spot such as pus, redness, increased pain, and
swelling

• Persistent chest pain of any type associated with nausea, sweating, left arm pain,
or any generalized chest pain that is not well localized: These symptoms can be
signs of a heart attack. If you are not sure what is causing your condition, always
go to the emergency department.

Exams and Tests

Costochondritis does not lend itself to diagnosis by tests. Personal history and physical
exam are the mainstays of diagnosis. Tests however are sometimes used to rule out other
conditions that can have similar symptoms but are more dangerous, such as heart disease.

• The doctor will seek to reproduce tenderness over the affected rib joints, usually
over the fourth to sixth ribs in costochondritis, and over the second to third ribs in
Tietze syndrome. In costochondritis with unknown causes, there is no significant
swelling of costochondral joints.

• There is swelling as well as tenderness of the rib-cartilage junctions in Tietze

syndrome. Although some doctors use the terms costochondritis and Tietze
syndrome interchangeably, Tietze syndrome has a sudden onset without any
preceding respiratory illness or any history of minor trauma. In Tietze syndrome,
there is frequently radiation of pain to arms and shoulders as well as pain and
tenderness associated with swelling at the spot that hurts.

• Blood work and a chest x-ray are usually not helpful in diagnosing
costochondritis. However, after sternum surgery, or for people at risk for heart
disease, doctors will be more likely to do tests if you have chest pain and possible
costochondritis to be certain you do not have any infection or other serious
medical problems.

o They will look for signs of infection such as redness, swelling, pus, and
drainage at the site of surgery.
 o A more sophisticated imaging study of the chest, a gallium scan, is used to
check for infection. It will show increased uptake of the radioactive
material gallium in an area of infection.

o In cases of possible infection, the white blood cell count may be elevated.

o Chest x-ray should be obtained if pneumonia is a suspected cause of chest

pain.

o ECG and other tests will be done if a heart problem is being considered.

• Costochondritis is a less common cause of chest pain in adults but one that occurs
fairly frequently in people who have had cardiac surgery. The diagnosis can only
be reached after excluding more serious causes of chest pain that are related to the
heart and lungs. The appropriate studies, such as ECG, chest x-rays, blood test for
heart damage (cardiac enzymes and troponin levels), and other studies will be
done as indicated. Any chest pain in adults is taken seriously and not ignored. If
you are concerned, consult with your doctor.

Costochondritis Treatment

Self-Care at Home

• Treatment involves conservative local care with careful use of nonsteroidal

antiinflammatory medications such as ibuprofen (Advil, Motrin) or
naproxen (Aleve) as needed.

• Local heat or ice may be helpful in relieving the symptoms.

• Avoid unnecessary exercise or activities that make the symptoms worse. Avoid
contact sports until there is improvement in symptoms, and then return to normal
activities only as tolerated.

Medications

• Costochondritis responds to nonsteroidal antiinflammatory medications such as

ibuprofen (Advil or Motrin) and naproxen (Aleve).

• You may be given a local anesthetic and steroid injection in the area that is tender
if normal activities become very painful and the pain does not respond to
medications.

• Infectious (bacterial or fungal) costochondritis should be treated initially with IV

antibiotics. Afterward, antibiotics by mouth or by IV should be continued for
another two to three weeks to complete the therapy.
Learn about antiinflammatory medications like ibuprophen (Advil, Motrin) on
RXList.com.

Surgery

Surgical removal of the sore cartilage may be required if there is no response to medical
therapy. Your doctor will refer you to a surgeon for consultation should this option be
considered necessary.

Prevention

Because inflammatory costochondritis has no definite cause, there is no good way to

prevent it.

Outlook

Noninfectious costochondritis will go away on its own, with or without antiinflammatory

treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgical repair, but

recovery may take a long time.

Synonyms and Keywords

Tietze syndrome, chest pain, sore ribs, costal chondritis, costochondritis