Costochondritis

What costochondritis is

The upper ribs connect to the breastbone through flexible cartilage at the costosternal and costochondral joints. In costochondritis, these joints become inflamed and painful. There is no swelling, which distinguishes it from Tietze syndrome.

Symptoms

• sharp, stabbing, aching or pressure-like pain at the front of the chest
• usually on the left side, at the 2nd to 5th rib joints, often more than one level
• tenderness when pressing on the affected joints
• pain worse with deep breaths, coughing, sneezing, lifting, twisting or lying on the chest
• pain that may spread across the chest or into the upper belly

The pain can be intense and frightening, and many people first worry about their heart.

Costochondritis vs heart attack

Tenderness does not rule out a heart problem. Anyone with new chest pain, especially with risk factors, should be assessed, and an ECG is often done.

Causes

The cause is often unknown. Known triggers include:

• repeated coughing, as with a chest infection
• strain from heavy lifting, new exercise or repetitive upper-body activity
• minor injury to the chest
• viral infections
• infection after chest surgery or injection drug use (rare)
• inflammatory arthritis such as ankylosing spondylitis or psoriatic arthritis

It is also more common in people with fibromyalgia.

Related conditions

• Tietze syndrome: inflammation with visible swelling, usually at a single joint (often the 2nd or 3rd rib), mostly in people under 40.
• Slipping rib syndrome: pain at the lower ribs with a clicking or popping sensation.
• Precordial catch syndrome: brief, sharp chest pains in children and teens lasting seconds to minutes.

Diagnosis

Costochondritis is diagnosed by examination: pain reproduced by pressing on the rib joints, with no other cause found. Depending on age and symptoms, a doctor may order:

• an ECG and sometimes blood tests (troponin) to exclude a heart problem
• a chest X-ray to look for lung problems or fractures
• blood tests for inflammation if arthritis is suspected

Treatment

• Avoid aggravating activities such as heavy lifting, push-ups or repetitive arm work for a few weeks.
• Heat or ice on the chest for 15 to 20 minutes several times a day.
• NSAIDs such as ibuprofen or naproxen, following the label dose, for 1 to 2 weeks. Avoid them if you have stomach ulcers, kidney disease or take blood thinners. Topical NSAID gels are an alternative.
• Acetaminophen (paracetamol) for pain relief if NSAIDs are unsuitable.
• Gentle stretching of the chest muscles, such as doorway stretches, once the acute pain eases.
• Physical therapy for persistent cases.
• Steroid or anesthetic injections into the painful joints for stubborn pain.
• Treating the trigger, such as a chronic cough.

Outlook

Costochondritis usually improves within a few days to weeks. Some people have pain for several months, and it can come back. It does not damage the heart or lungs.

Frequently asked questions

What does costochondritis feel like?

It feels like sharp, stabbing or aching pain at the front of the chest beside the breastbone, usually on the left. The area is tender to press, and pain worsens with deep breaths, coughing and upper-body movement.

How can I tell if chest pain is costochondritis or my heart?

Costochondritis pain is usually sharp, localized and reproduced by pressing on the chest. Heart pain is more often pressure or squeezing, spreads to the arm or jaw, and comes with sweating or breathlessness. You cannot be sure on your own, so get new chest pain checked.

How long does costochondritis last?

Most cases improve within a few days to a few weeks. Some last several months, and it can recur. Avoiding aggravating activities and using anti-inflammatory treatment usually speeds recovery.

What triggers costochondritis?

Common triggers include repeated coughing, heavy lifting, new or strenuous exercise, minor chest injury and viral infections. Often no clear trigger is found. Rarely, infection or inflammatory arthritis is the cause.

Can stress cause costochondritis?

Stress does not directly inflame the rib joints, but it can increase muscle tension and pain sensitivity, making chest wall pain feel worse. Anxiety can also cause chest pain on its own. A doctor can help sort out the cause.