Costochondritis: Causes, Symptoms, & Treatment

Costochondritis is the inflammation of the cartilage between one or several ribs and the breastbone. It is also known as costosternal syndrome, anterior chest wall syndrome, or parasternal chondrodynia. It can affect people of all ages, and will resolve on its own in time. While its symptoms can be uncomfortable, costochondritis isn’t dangerous. However, it is important to distinguish it from other causes of chest pain.

What Is Costochondritis?

Costochondritis is the inflammation of one or more costochondral joints, which joins your breastbone (or sternum) to your ribs. This inflammation results in costochondritis pain, which can vary from mild (chest tender to the touch), to intense (shooting pains down your body). The pain may worsen with a deep breath or coughing. Though the area may be sore, there should not be redness, heat, or swelling.

Costochondritis typically gets better on it’s own but the time it takes is variable. Sometimes the pain goes away after a few weeks while other times it can be a few months. One study showed that about a third of patients still had some tenderness after one year.

What Causes Costochondritis?

Most of the time, the cause for costochondritis is unknown. However, sometimes the condition can be brought on by a strain to the area, including:

• Injuries: Trauma to the chest, causing forceful impact.
• Strain: Physical strain, related to hard workouts, heavy lifting, or excessive coughing.

Those who experience anxiety and/or stress may sometimes experience chest pain. However, chest pain caused by anxiety is most likely due to other underlying causes—not costochondritis. While costochondritis can be caused by activities that put stress or strain on your chest area, it isn’t known to be connected to emotional stress.

Costochondritis Symptoms

If you have costochondritis, you will experience pain in the chest wall, which may be difficult to tell apart from general chest pain. It can be anywhere along the seven costochondral junctions, although it is most common in the middle to upper ribs. The pain can affect just one rib, or multiple. Usually only the ribs of one side are inflamed, although it is possible for both sides to have costochondritis. The pain can be worse especially with coughing, taking a deep breath, applying pressure to the rib joints, or moving your arms excessively.

Diagnosing Costochondritis

Chest pain can be concerning and sometimes it is hard to tell what is serious chest pain and what is costochondritis. If you’re experiencing chest pain, you should consult a medical professional to rule out other serious issues.

To diagnose costochondritis, your doctor will first do a complete health intake, asking you about your symptoms, and may inquire about recent activities or illness that could contribute to the cause. He or she will then conduct a physical examination, including listening to your heart and lungs, and palpating the ribs and chest wall.

If your doctor is concerned about something other than costochondritis causing your chest pain, such as heart or lung conditions, he or she may recommend blood tests, electrocardiography, or chest radiography to gather more information.

Costochondritis Treatment Options

Costochondritis treatment options usually focus on reducing pain, and may include home remedies and medications.

Home remedies

• Heat: Try using a heating pad or hot compress on a low setting, for short periods several times a day.
• Rest: Avoid activities that bring on the pain, but you may resume when you are feeling better.
• Over-the-counter (OTC) pain relievers: OTC pain relievers like naproxen sodium (Aleve), ibuprofen (Advil), or acetaminophen (Tylenol) can help control pain. OTC topical pain creams can also provide relief.
• Avoid coughing: If coughing is triggering your symptoms, OTC cough suppressants can help prevent flares.
• Stretching: Easy stretching exercises to help gently open your chest muscles may help you feel better.

Prescribed treatments

Your doctor may prescribe the following treatments:

• Prescribed nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs prescribed by your doctor can help calm inflammation and pain. When used excessively or in someone with other health issues, the drugs do have potential side effects, so use with caution. Side effects include causing damage to the kidneys, liver, and stomach, or worsening heart failure or blood pressure. You can also be prescribed a topical form that has fewer side effects.
• Physical therapy: Physical therapy can be helpful in relieving chest wall pain.
• Muscle relaxants: Pills that relax the muscles, such as cyclobenzaprine (Flexeril) are sometimes used to ease pain.
• Antidepressants: There are some prescription antidepressants that help provide pain relief for persistent costochondritis. If your costochondritis is causing constant pain, tricyclic antidepressants (i.e. amitriptyline) might help.
• Anti-seizure drugs: Gabapentin (Neurontin), an epilepsy medication, can also be helpful in reducing persistent pain.
• Injections: Local injections of numbing/steroid medicine into the joint are rarely used, but may help in very persistent, severe cases.

Risk Factors for Costochondritis

Those who have a higher risk for getting costochondritis are:

• Women (70% of cases are in women)
• Those involved in heavy manual labor
• People who engage in strenuous workouts or high-impact activity
• Individuals who are prone to frequent coughing or sneezing

Related Conditions

Tietze syndrome, often confused with costochondritis, has similar symptoms in the same area. However, Tietze syndrome includes joint swelling while costochondritis does not. In addition, Tietze syndrome is found in individuals under 40, while costochondritis can affect all ages.

Chest wall pain can also occur in other conditions such as:

• Fibromyalgia: Fibromyalgia is a disorder that causes widespread musculoskeletal pain and fatigue. Chest wall pain is more common in those with fibromyalgia.
• Arthritis: Inflammation of the chest wall can also be seen in rheumatoid arthritis or other inflammatory arthritis conditions, such as ankylosing spondylitis, psoriatic arthritis, or lupus.
• Infection: While uncommon, infections can cause pain and swelling in the joints, among other symptoms.
• Tumors: Rarely, cancerous and noncancerous tumors can develop in the chest wall.

When to See a Doctor

Whenever you are experiencing chest pain, you should see a doctor immediately to rule out anything more serious. For example, if you are experiencing chest pain with other symptoms such as shortness of breath, nausea, sweating, dizziness, or left arm pain, these can be signs of a heart attack and you should seek medical help immediately.

If you’ve already been diagnosed with costochondritis you should see a medical professional if any of the following symptoms appear:

• High fever
• Difficulty breathing
• Nausea
• Pain that continues to get worse
• Swelling
• Signs of infection, such as pus or redness

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