What is costochondritis?
Costochondritis is also known as Tietze’s syndrome. It is the inflammation of the costochondral joints. The costochondral joints are the intersections where the upper ribs join with the cartilage that connects them to the breastbone or sternum.
This inflammation may result in a chest pain which is localized to one site. This pain can be produced by pushing on the affected cartilage. Although it may sound a bit scary, costochondritis is relatively a harmless condition and it usually resolves spontaneously without any treatment. However some cases may require treatment.
However, costochondritis is an important condition to know about as it is a common cause of chest pain in children as well as adolescents. Nearly 10% to 30% of children are affected with costochondritis and the peak age of incidence is known to be between 12 to 14 years. Even in adults who present with a chest pain, costochondritis is a common condition that needs to be excluded.
Costochondritis affects females more than males – 70% of females develop costochondritis whereas only 30% of males develop this condition.
What causes costochondritis?
A definite cause for costochondritis has not yet been identified. However, repeated trauma to the chest wall, viral respiratory tract infections and the overuse of the arms are some of the possible causes which may cause chest pain due to costochondritis. People who are on IV drugs can also develop costochondritis as a result of bacterial infections.
Following surgery of the upper chest also makes it more prone to infection. This is because the blood flow to this region is reduced.
There are different types of infections that can lead to costochondritis. These include:
- Viral infections – This is the most common cause of costochondritis. This is due to the inflammation of the area because of the viral infection alone itself or due to the straining from coughing.
- Bacterial infections
- Fungal infections also can cause costochondritis. However they are rare causes of costochondritis.
There are other conditions that may cause costochondritis. They are:
- Physical strain from heavy lifting or strenuous exercises.
- Tumors in the costochondral joint.
Who is at risk of developing costochondritis?
Both males and females above the age of 40 years are at a risk of developing costochondritis. However Costochondritis affects females more than males – 70% of females develop costochondritis whereas only 30% of males develop this condition.
The risk of costochondritis is also high if you:
- Participate in manual labor
- Involve in high impact activities
- Are allergic to certain irritants and are frequently exposed to them
- Have rheumatoid arthritis
- Have ankylosing spondylitis
- Have Reiter’s syndrome which is also known as reactive arthritis.
What are the symptoms of costochondritis?
Chest pain is the most common symptom that many patients present with and is usually preceded by minor trauma, exercise or upper respiratory infections.
The chest pain is often described as a sharp pain localized to the anterior wall of the chest but sometimes can be a dull pain. It may radiate to the back or the abdomen and is more common to radiate to the left side. The pain can be exacerbated on movement, coughing or when taking deep breaths and the pain reduce when you stop moving or with shallow breathing. Since this presentation is similar to the symptoms of a heart attack it is important that you seek immediate medical care to exclude the possibility of a heart attack.
The common sites of pain include the fourth, fifth and sixth ribs of the anterior chest wall. On palpation of the affected ribs, there will be localized tenderness which is a characteristic feature of costochondritis. This means that if this feature is absent, then the diagnosis of costochondritis is unlikely.
There can also be swellings on the costochondral joints. However, there is not pus or abscess formation in the condition. This swelling can sometimes last for several months.
If costochondritis is following an infection, then you may notice signs of inflammation such as redness, swelling, or the discharge of pus.
When should you consult a doctor?
If you experience any of the following symptoms, then you should seek medical care:
- Difficulty in breathing
- Signs of infection such as discharge of pus, redness, and increased swelling at the rib joints.
- The chest pain does not respond to medication or is worsening while taking medication.
- Nausea and vomiting
- High fever
- Chest pain radiating to the let jaw or arm.
How is costochondritis diagnosed?
After taking a detailed history from you regarding the symptoms you experience, your doctor will do a complete physical examination before making a diagnosis. During the physical exam, your doctor will assess the severity of the pain as well as look for signs of any infection or inflammation.
Following this, he or she may order investigations such as a chest X-ray and certain other blood tests to rule out conditions that may cause similar symptoms. An electrocardiograph will also be done to exclude coronary heart disease or other heart condition.
How is costochondritis treated?
Treatment includes both lifestyle changes as well as medical therapy
This is especially advised for those who have persistent or chronic costochondritis. You will be asked to avoid exercises that may aggravate the condition such as weight lifting and running. Bed rest, physical therapy and hot or cold therapy are also useful tips to help reduce the costochondritis pain.
The main aim of medical therapy is to relieve the pain and this can be done by over the counter medications. The type of pain medication you will need depends on the severity of the pain. If it is mild to moderate, you will be prescribed non-steroidal anti-inflammatory drugs (NSAIDs) such as Naproxen and Ibuprofen. However, if there seems to be no response to these medications, then higher strength pain killers will be prescribes such as narcotics.
Sometimes you will be given a local anesthetic and steroid injections to the tender areas if the condition becomes very painful.
If there is an infection, then the infection will be treated with IV antibiotics followed by oral antibiotics.