Costochondritis: Complications, diagnosis, and treatment options

Chest wall pain or costochondritis, also called Tietze’s syndrome, is a condition in which inflammation occurs between the tissues that connect the rib to the sternum (breast bone). For some people, this pain can be alarming because it may feel similar to the pain caused by an oncoming heart attack.

What is costochondritis?

Costochondritis is often caused by temporary inflammation of the costal cartilage found between the ribs and sternum at the costosternal joint. This often causes chest pain that simply resolves on its own, but until then, it is considered a medical emergency as symptoms may resemble that of a heart attack. Once cardiac etiologies have been ruled out, investigation for alternative causes of chest pain can begin.

Costochondritis accounts for nearly 10–30 percent of all chest pain in children, with the peak age of the condition occurring at 12–14 years of age. Adults suffering from this form of chest pain tends to be more worrisome as it could potentially be interpreted as a sign of heart problems, leading doctors to perform a battery of tests to rule it out. Costochondritis is known to affect females more than males (70 percent vs 30 percent) and also be the result of an infection or even a complication of surgery to the sternum.

What are the causes of costochondritis?

There is usually no clear cause for the development of costochondritis, however, the condition may be caused by any of the following:

• Injury: Blunt injury to the breastbone may lead to the development of costochondritis.
• Physical strain: Costochondritis may be caused by heavy lifting, strenuous exercise, and even severe coughing.
• Arthritis: Conditions such as osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis may lead to chest pain originating from the costosternal joint.
• Joint infection: Infections leading to tuberculosis, syphilis, and aspergillosis can affect the rib joint, leading to a diagnosis of costochondritis.
• Tumors: Cancers may spread from one point of the body to another, such as the breast, thyroid, or lung. These areas may present with chest pain as a result.
• Fibromyalgia: A condition affecting muscles and soft tissue, which may present as feelings of pain in the chest wall and rib cage.
  Pulmonary embolism: Due to a blood clot that travels from elsewhere in the body and becomes lodged in the lung, preventing the flow of blood. This is a life-
• threatening condition presenting as chest pain.
• Pneumonia: Commonly due to infectious bacteria that leads to inflammation of the pleura or membranes surrounding the lungs. Chest pain, tenderness, and aching often worsen upon inhalation.

Symptoms of costochondritis

• Commonly seen symptoms:
• Chest pain: May be dull but is usually sharp in nature and isolated to the front wall. Occasionally, pain may radiate to the back or abdomen, with the left side being more commonly affected.
• Pain with deep breaths
• Cough
• Rib pain: Common sites of pain are your fourth, fifth, and sixth ribs. Pain typically increases with movement of the trunk or while taking deep breaths. Patients can often find relief by decreasing movements and breathing quietly.
• Tenderness: Pressing on the costochondral junction (rib joints) will often produce pain and is a constant feature of costochondritis.

You should seek medical care if experiencing the following symptoms:

• Trouble breathing
• High fever
• Nausea
• Sweating
• Worsening pain
• Signs of infection (redness, pus, and increased swelling at the rib joints)

Chest wall pain (Costochondritis) Complications

Pain from costochondritis may be temporary, but if it is chronic it can be quite debilitating. This pain can return during physical activity or even everyday tasks, so costochondritis can really negatively impact a person’s quality of life.

First and foremost, if pain is constant, you will want to rule out other causes, including heart problems or even pneumonia. If these are ruled out, then your doctor may test for fibromyalgia, because costochondritis is a common symptom of fibromyalgia.

In fibromyalgia, you experience pain throughout the body, fatigue and inability to rest due to pain, difficulty focusing or concentrating, feelings of depression, and headaches.

Treatment options and diagnosis for costochondritis

Diagnosing costochondritis

Serious cases of chest pain will usually be looked into further. A full workup including medical history and a physical exam will be done to rule out potential cardiac causes. This is often the first step in all serious cases of chest pain. It will help provide any additional clues that can be used as evidence before proceeding to additional testing. Generally, once life-threatening causes of chest pain have been ruled out and tenderness along the sternum is identified, a diagnosis of costochondritis can be made. Additional tests to rule out other conditions may include:

Blood tests: Looking for cardiac enzymes within the blood that indicates a previous episode of myocardial infarction (heart attack) has occurred.

Electrocardiogram (ECG/EKG): This test is used to measure electrical signals that are produced when the heart contracts. Electrodes are attached to the chest at various points to get an idea of how well the heart contracts and whether there are any abnormalities. This will be clearly seen on the ECG tracing.

Echocardiogram: The use of sound waves that are able to produce real-time images of the heart muscles can reveal thickened muscle tissue of the left ventricle, blood flow through the heart with each beat, and other cardiac abnormalities.

Chest X-ray: A simple imaging test that is able to provide physicians with a good approximation of heart size and health status of the lungs.

Treating costochondritis

Typical treatment of costochondritis includes taking anti-inflammatory medications, physical therapy, and – in very serious cases – surgery.

Common treatments include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): A common pain-relieving medication that can be found in many pharmacies and grocery stores. They are designed to reduce pain and swelling. However, long-term use of these drugs may lead to liver damage and even increase the risk of heart attacks. NSAIDs can also be found in topical solutions and don’t pose as much of a risk as oral formats.
• Narcotics: Often reserved for severe pain and can only be prescribed by a doctor. These medications include codeine such as hydrocodone/acetaminophen (Vicodin, Norco) or oxycodone/acetaminophen (Tylox, Roxicet, Percocet).
• Other medications: Amitriptyline, a tricyclic antidepressant, has been known for helping to control unwanted pain. The commonly used anti-seizure drug gabapentin (Neurontin) has also shown some benefit for controlling chronic pain.
• Heat or ice: Helps provide pain relief and make you feel more comfortable.
• Rest: It is recommended to avoid activities that may exacerbate costochondritis pain.

Costochondritis will go away on its own, but if you notice the pain is sticking around for weeks, seek out medical attention.

Any case of chest pain should not be ignored, as it can be difficult to say for sure that it is due to serious or non-serious causes. However, using your better judgment and recognizing that your particular cause is not normal will be the first step in recovery. With the help of a medical professional, you can find the reasons behind your particular case of chest pain, helping you address potential harmful medical conditions as soon as possible.